Caring for Patients on Opioids Lorri Shaver, PharmD Shanna OConnor, - - PDF document

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Caring for Patients on Opioids Lorri Shaver, PharmD Shanna OConnor, - - PDF document

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10/18/19 1 Caring for Patients on Opioids Lorri Shaver, PharmD Shanna OConnor, PharmD Caitlin Brown, PharmD 2 1 10/18/19 Disclosure There are no relevant financial rela5onships with ACCME- defined commercial interests for anyone who

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Caring for Patients on Opioids

Lorri Shaver, PharmD Shanna O’Connor, PharmD Caitlin Brown, PharmD

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Disclosure

There are no relevant financial rela5onships with ACCME- defined commercial interests for anyone who was in control

  • f the content of the ac5vity.

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Pharmacist and Pharmacy Technician Learning Objectives

  • Describe workflow best practices for utilizing prescription

drug monitoring programs.

  • List non-opioid pain treatment including, but not limited to,
  • ther prescription and non-prescription medications and

non-pharmacologic treatments.

  • Discuss how to best document interventions in the patient

care plan.

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Plan for Today

  • PDMP Refresher
  • Worksheet activities
  • Workflow Best Practices and Resources
  • Worksheet activities
  • Alternate therapeutic options for pain treatment
  • Case and engagement
  • Documentation strategies
  • Worksheet activities

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Orientation to handout and worksheet

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Potato Pharmacy: Normal Tuesday

  • Mr. Spud is a 34-year-old male with complaints of chronic pain. He is

currently taking oxycodone 10mg BID and hydrocodone/APAP 5/325 Q4h prn. He presents to the pharmacy with new prescriptions for

  • xycodone 15mg BID and hydrocodone/APAP 7.5/325 Q4h prn. You

look back in his record and note a steady increase in MME over the past 6 months and he is 10 days early.

  • Does this sound familiar?
  • What happens next?

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What should be done for Mr. Spud?

  • Corresponding Responsibility
  • Call the physician
  • Call the insurance
  • Document
  • Naloxone Protocol?

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Activity

  • Who does what in your pharmacy
  • Initial opioid assessment
  • Checking PDMP
  • Documenting PDMP
  • Offering enhanced services related to opioids
  • Delivering enhanced services related to opioids
  • Documenting enhanced services related to opioids

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PDMP Refresher

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PrescripKon Drug Monitoring Programs (PDMP)

  • National Association of State Controlled Substances

Authorities: PDMP resources, interactive US map

  • National Association of Boards of Pharmacy: State sharing

information

  • Centers for Disease Control and Prevention: educational

information, handouts, app

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Submitting to PDMP

  • Who is required to submit informa5on to PDMP?
  • h`p://www.pdmpassist.org/pdf/Mandatory_condi5ons_use.pdf
  • Most pharmacy sobware placorms report directly to PDMP

through PMP Clearinghouse

  • Can be done through pharmacy sobware, online report

upload, manual entry

  • See your specific state regula5ons

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Workflow best practices for prescription drug monitoring programs

Notable or want to try? Mark on your worksheet

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Literature-guided

  • Risk-stratified, patient-centered screening
  • Open-ended questions paired with active listening
  • Identify red flags related to opioid misuse
  • Check the PDMP as part of workflow
  • Advocate for safe medication disposal

(www.deadiversion.usdoj.gov/drug_disposal/index.html)

  • Naloxone access
  • Referral
  • Prescribing under collaborative practice/protocol
  • Independent prescribing

Reynolds V et al. N C Med J. 2017; 78(3): 202-205.; Kennedy-Hendriks A et al. JAMA Intern Med. 2016;176(7):1027- 1029.

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Sample Workflow

Example Workflow

Rx Drop-off <50 MME Dispense Rx >50 MME In store or picking up later Opioid Monitoring Form Packet reviewed at checkout, offer naloxone Someone else is picking up Send packet home to patient Call patient in 7 days to check status Must have signed packet on file before dispensing 3rd opioid fill Delivery Send packet with driver Bring (or mail) back signed packet Mail or deliver naloxone if desired by patient

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Another workflow

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Pause: Brainstorm

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PDMP Tools

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PDMP Resources

http://www.nascsa.org/rxMonitoring.htm

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NASCA Map of State Profiles

http://www.nascsa.org/stateprofiles.htm

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PDMP Resources

http://www.nascsa.org/rxMonitoring.htm

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Working at the top of licenses

  • What steps in workflow does your state MANDATE be

completed by pharmacists?

  • What roles can technicians take on?
  • What role can cashiers have?

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Worksheet: What works for your workflow

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Potato Pharmacy: Normal Tuesday

  • Mr. Spud is a 34-year-old male with complaints of chronic pain. He is

currently taking oxycodone 10mg BID and hydrocodone/APAP 5/325 Q4h

  • prn. He presents to the pharmacy with new prescriptions for oxycodone

15mg BID and hydrocodone/APAP 7.5/325 Q4h prn. You look back in his record and note a steady increase in MME over the past 6 months and is 10 days early.

  • What kind of pain is Mr. Spud experiencing? Is his pain regimen
  • ptimized?

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Review of non-opioid pain treatment

  • What questions might we ask Mr. Spud in order to better

assess his pain?

  • Brief Pain Inventory: http://www.npcrc.org/files/news/briefpain_long.pdf
  • Opioid Therapy Assessment: http://www.trmc.net.au/pdf/sixas-opioid-therapy-monitoring-tool.pdf
  • Substance Misuse Assessments: SOAPP-R, DIRE Score, Opioid Risk Tool, SBIRT, CAGE-AID
  • Sensory, affective, cognitive, psychiatric, psychosocial, trauma, and sleep assessments
  • What therapy can we recommend to augment Mr. Spud’s

current pain regimen?

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Review of non-opioid pain treatment options

  • Using the drug table posted online, compare and contrast

non-opioid treatment options available

  • Indications
  • Side effects
  • Potential drug duplication(s)

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Review of non-opioid pain treatment

  • What therapy can we recommend to augment Mr. Spud’s

current pain regimen?

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Potato Pharmacy: Normal Tuesday

  • Ms. Tot is a 42-year-old female with complaints of pain. She

has arthritis in her hands, lower back pain (throbbing, sharp pain, and tingling/burning pain).

  • What drug categories may be appropriate for Ms. Tot?
  • How might an assessment of Ms. Tot be offered and delivered in

your pharmacy?

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Patient care documentation

  • For the following patient cases, choose at least two and

document as you would in an eCare plan

  • Things to think about:
  • When do you need to follow-up?
  • How do you ensure that follow-up happens?
  • Who else should be made aware of your intervention?

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Potato Pharmacy: DocumenKng PaKent Care

  • Mr. Spud
  • After a discussion and counseling session, you recognize that Mr. Spud may have a

need for naloxone at home to avoid overdose. You can prescribe under protocol with a local physician so write and fill the prescription.

  • Ms. Tot
  • You make the recommendation that Ms. Tot try acetaminophen 650mg Q 6 hours for

her chronic pain.

  • Cheecie Tatr (non-binary)
  • You make the recommendation that Cheecie Tatr try ibuprofen 400mg Q 6 hours

with food for their acute pain needs.

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Wrap Up

  • Workflow implementation of opioid interventions
  • Patient care opportunities and documentation
  • Resources for finding out more information

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Thank you for your participation!

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Lorri Shaver, PharmD Shanna O’Connor, PharmD Caitlin Brown, PharmD

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