Pharmacy Clinical Decision Support Tools for Improving Opioid Safety - - PowerPoint PPT Presentation
Pharmacy Clinical Decision Support Tools for Improving Opioid Safety LTC Mark Maneval, RPh, PhD Chief, Pharmacy Clinical Decision Support Enterprise Intelligence and Data Solutions (EIDS) PMO Deputy Assistant Director for Information Operations
LTC Mark Maneval, RPh, PhD Chief, Pharmacy Clinical Decision Support Enterprise Intelligence and Data Solutions (EIDS) PMO Deputy Assistant Director for Information Operations Defense Health Agency
The American Pharmacist Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
Mark Maneval declares no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. The views expressed in this presentation are those of the author and do not necessarily reflect the official policy or position of the Department of the Army, Defense Health Agency, Department of Defense, nor the U.S. Government.
Target Audience: Pharmacists and Pharmacy Technicians ACPE#: 0202-0000-18-216-L04-P/T Activity Type: Knowledge-based
1.
Explain how to use the Opioid Registry to identify opioid patients who naloxone may be indicated.
2.
Identify clinical, medication, MEDD and encounter based factors associated with a higher probability of opioid induced respiratory depression.
3.
State how to quickly and easily screen patients for risk of opioid induced respiratory depression at the pharmacy using the Patient Lookup Tool.
1.
What is the fastest way to estimate the probability of opioid induced respiratory depression and obtain a recommendation for who may need naloxone?
calculate it by hand
2.
Which of the following are risk factors used in the Opioid Registry’s predictive model for opioid induced respiratory depression?
half life (Oxycontin, Methadone, Fentanyl patch, etc.)
3.
The Patient Look-up Tool requires special equipment and training to access and use.
“Pharmacists now must consider the best interests of patients and provide consultation to patients and/or prescribers if prescribed medications pose preventable risks for patients.”
David Brushwood, JD, column coordinator, and Professor Emeritus of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville
www.pharmacist.com/evolving‐responsibilities‐pharmacy downloaded 28 Sep 2018
Problem:
Patient information is lacking at point of care
Hypothesis:
Better Information → Better Care → Better Outcomes
Solution:
Display patient information at point of care
Information Sharing: Apps Personalized Gallery Items Collections Sites Enhanced Landing Page and
Navigation
Enhanced Search and Filters Community Contribution
https://carepoint.health.mil
https://carepoint.health.mil
Measure Construct DoD Definition/Description Long‐Term Opioid Therapy (LOT) LOT Use Among DoD Beneficiaries Number of patients on LOT during reporting period. LOT is defined as 90 days
reported as percentage of enrolled population by enrollment DMIS. Long‐Term Opioid Therapy (LOT) <=30 Years Old Among LOT Patients Of the LOT patients, number & proprtion <= 30 years of age Any Opioid Usage Any Opioid Usage Among DoD Beneficiaries Presence of any opioid Rx during the reporting period among DoD beneficiaries Any Opioid Usage Long vs Short Acting Opioids Of the patients receiving opioids, breakdown of long vs short acting opioids Concomitant Medications Concurrent Use of Opioids & Benzodiazepines Percentage of individuals 18 years and older with concurrent use of prescription opioids and benzodiazepines.
Measure Construct DoD Definition/Description Morphine Equivalent Daily Dose (MEDD) Median Morphine Equivalent Daily Dose (MEDD) for LOT Patients The median MEDD value for patients identified as LOT users during the measurement period at each level of care from the MHS down to the provider level Morphine Equivalent Daily Dose (MEDD) >= 90 MEDD Among LOT Patients Of the LOT patients, number and proportion of patients with >= 90 MEDD Morphine Equivalent Daily Dose (MEDD) 20‐50 MEDD Among LOT Patients Of the LOT patients, number and proportion of patients with an MEDD value
Naloxone Naloxone Use Among LOT Patients Proportion of patients on long term opioid therapy (LOT) who have received
1) Have received naloxone over the past 12 months OR 2) Have an average morphine equivalent daily dose (MEDD) ≥ 50 mg and have received naloxone in the past 12 months OR 3) Have an average morphine equivalent daily dose (MEDD) ≥ 90 mg and have received naloxone in the past 12 months Naloxone Naloxone Dispensings Among High RIOSORD/STORM Population Number and percentage of opioid users with RIOSORD >32 or STORM scores in the 'high' or 'very high' categories that were dispensed Naloxone
Measure Construct DoD Definition/Description Risk Scores Mean RIOSORD Score Mean RIOSORD score among LOT patients during reporting period Risk Scores Mean STORM Score Mean STORM score during reporting period Risk Scores High RIOSORD Score Population Number and percentage of opioid users with a RIOSORD score > 32 Risk Scores High STORM Score Population Number and percentage of opioid users with a STORM score in the 'high' or 'very high' categories Mental Health PTSD Among LOT Patients Presence of PTSD diagnosis among LOT users in the past year Mental Health Depression Among LOT Patients Presence of depression diagnosis among LOT users in the past year Mental Health Suicide Risk Among LOT Patients Presence of suicide related diagnosis among LOT users in the past year Urine Drug Testing (UDT) Urine Drug Testing in LOT Users Presence of opioid related UDT among LOT users in the past year Therapy Duration Median Duration of Opioid Therapy Among Long‐Term & Short‐Term Users Median number of prescription opioid therapy days during the measurement year for (1) LOT users and (2) short‐term users Therapy Duration Comparison of Patients on Long vs Short Acting Opioids Average length of therapy among patients on long vs short acting opioids
Pharmacy is the most frequent touchpoint in the healthcare system Pharmacy is not a count, lick, stick and pour business anymore The Patient Lookup Tool provides a pharmacy based clinical decision support tool
that identifies risk of respiratory depression and potential need for naloxone
Access the Opioid Registry, Patient Look-up Tool and Dashboard thru the
CarePoint Information Portal at https://carepoint.health.mil
Clinical pharmacy integration of CarePoint registries and reports aligns with the
DHA Quadruple Aims: Better Care, Better Health, Lower Cost and Improved Readiness
1.
What is the fastest way to estimate the probability of opioid induced respiratory depression and obtain a recommendation for who may need naloxone?
calculate it by hand
2.
Which of the following are risk factors used in the Opioid Registry’s predictive model for opioid induced respiratory depression?
dependence
variable half life (Oxycontin, Methadone, Fentanyl patch, etc.)
3.
The Patient Look-up Tool requires special equipment and training to access and use.