Ensuring proper opioid prescribing during hospital discharge

      The opioid epidemic continues to touch every facet of pharmacy practice, from the community setting to the health-system environment. An important component of curbing the crisis is implementing proper prescribing practices. A recent study looked at the frequency of opioid prescribing at hospital discharge to shed light on hospital pain management guidelines.

      New opioid prescriptions postdischarge

      “Clearly, hospital pharmacists are in an excellent position to work with the health care team to craft an appropriate pain management plan for patients with acute and chronic pain,” said Mary Lynn McPherson, PharmD, MA, BCPS, CPE, professor and executive director of advanced postgraduate education in palliative care at University of Maryland School of Pharmacy. “Pharmacists spend many years becoming experts on drug therapy and are in an excellent position to recommend rational polypharmacy analgesic regimens.”
      In a study published in the July issue of JAMA Internal Medicine, researchers analyzed claims from a random sample of patients hospitalized in 2011 who had no opioid prescriptions in the 60 days prior to admission. The study authors reported that across 2,512 hospitals, about 15% of previously opioid-naive Medicare beneficiaries filled a new prescription for an opioid within 7 days of hospital discharge, and approximately 40% filed a claim for an opioid 90 days after discharge. Compared with medical hospitalizations, surgical hospitalizations were twice as likely to be associated with opioid use postdischarge, noted the investigators.
      “The authors concluded that despite the wide variability in opioid prescribing among hospitals evaluated, it is not possible to determine differences in appropriate or inappropriate prescribing practices,” explained McPherson in an interview with Pharmacy Today. “However, it is critically important that practitioners prescribe opioids when clearly indicated, in an appropriate amount and duration, and with appropriate follow-up.”

      Making recommendations

      Hospital pharmacists can make interventions at many points to ensure appropriate opioid prescribing. “Medical records are generally more robust in a hospital setting; therefore, the hospital pharmacist can review the past medical history and collaborate with the health care team to develop a discharge pain management plan that targets the likely trajectory of the pain, including both pharmacologic and nonpharmacologic interventions,” said McPherson.
      She noted that not all types of pain are considered to be particularly opioid responsive, and hospital pharmacists can help determine the best pain medication for the patient’s pain type. McPherson added that hospital pharmacists could provide patient and family education to help them have appropriate expectations and understand the role of analgesics.
      In the big picture, a plan for monitoring patients is critical, along with the ability to make modifications. “We must address the competing public health crises of opioid misuse and abuse and poorly controlled chronic pain on all fronts,” said McPherson.

       New York e-prescribing turns 6 months old

      New York is now the top e-prescribing state in the nation, following the March adoption of a mandate requiring that all prescriptions be submitted to pharmacies electronically. The Internet System for Tracking Over-Prescribing (I-STOP) Act, aimed at reducing opioid overprescription and paper prescription fraud, created a prescription drug monitoring program (PDMP) and established penalties for prescribers who fail to comply.
      Surescripts reported in August that more than 96% of New York pharmacies are e-prescribing controlled substances (EPCS)–enabled, compared with 87% nationally; 69.6% of prescribers use EPCS—well over the national average of 12%.
      “It’s too early to tell, statistically, the impact on opioids, but prescribers are more informed than ever about the controlled substances a patient may be taking. A well-informed prescriber is more likely to make better decisions with their patients,” said Nick Barger, PharmD, principal pharmacist at DrFirst.
      At 6 months, there are still unresolved kinks in the system. “The electronic prescription mandate is creating an efficient, secure, and closed prescription-ordering process that is achieving its original goals of reducing errors, improving medication adherence, and preventing diversion,” said Kathy Febraio, CAE, executive director of the Pharmacists Society of the State of New York. “However, it does not allow for pharmacists to electronically transfer a prescription to another pharmacy to accommodate requests from patients, address out-of-stock medications, or rectify when the pharmacy receives the prescription in error.”
      Barger added that more work remains to facilitate “access to PDMP data within a prescriber’s chosen workflow.”
      Rachel Balick, Assistant Editor