Assessing the safety monitoring of chronic opioid prescribing for pain in a family medicine residency clinic

Additional Authors

James L. Owens, PharmD Candidate, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN. Mary Axelrad, MD, Department of Family Medicine, ETSU Family Medicine, Bristol, TN.

Abstract

INTRODUCTION: Opioid stewardship is imperative to promote safe use of a drug class with significant risks for adverse events, addiction, overdose, and death. The single family medicine clinic analyzed has an internal opioid prescribing policy which includes required yearly informed consent, yearly agreement to treat, periodic urine drug screens, routine controlled substance monitoring database review, limiting benzodiazepine co-prescriptions, and naloxone prescribing under certain criteria. The objective of this study was to review compliance with internal policies and identify gaps for improving opioid stewardship. METHODS: This retrospective chart review was conducted as a quality improvement project at one center after implementation of a revise opioid prescribing policy in August of 2024. It was determined to not be human subject research upon review by the institutional review board. Patients included attended a clinic visit between 11/1/2024 and 11/30/2024 and needed an active opioid order. Patients were excluded if the opioid prescription came from an outside prescriber or if the patient was currently staying in a nursing home. Descriptive statistics were utilized for analysis of each required monitoring component. Data collected included informed consent, agreement to treat form, last urine drug screening (UDS), and last controlled substance monitoring database (CSMD) check prior to appointment date. Pharmacy student review of current medication list was used to identify the amount of benzodiazepine co-prescriptions, naloxone prescriptions, and total daily morphine milligram equivalence (MME). RESULTS/CONCLUSIONS: Data analysis is ongoing. Preliminary results identified 73 encounters that met criteria for audit. Reasonable congruence is expected with internal opioid policies which mirror state and national guidance on safe prescribing. It is anticipated to find need for minor improvement across most categories and significant opportunity to increase naloxone prescriptions. This study highlights the importance of opioid stewardship and proactively monitoring of site-specific policies.

Start Time

16-4-2025 9:00 AM

End Time

16-4-2025 11:30 AM

Presentation Type

Poster

Presentation Category

Health

Student Type

Graduate Student - Doctoral

Faculty Mentor

Brandi Dahl

Faculty Department

Pharmacy Practice

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Apr 16th, 9:00 AM Apr 16th, 11:30 AM

Assessing the safety monitoring of chronic opioid prescribing for pain in a family medicine residency clinic

INTRODUCTION: Opioid stewardship is imperative to promote safe use of a drug class with significant risks for adverse events, addiction, overdose, and death. The single family medicine clinic analyzed has an internal opioid prescribing policy which includes required yearly informed consent, yearly agreement to treat, periodic urine drug screens, routine controlled substance monitoring database review, limiting benzodiazepine co-prescriptions, and naloxone prescribing under certain criteria. The objective of this study was to review compliance with internal policies and identify gaps for improving opioid stewardship. METHODS: This retrospective chart review was conducted as a quality improvement project at one center after implementation of a revise opioid prescribing policy in August of 2024. It was determined to not be human subject research upon review by the institutional review board. Patients included attended a clinic visit between 11/1/2024 and 11/30/2024 and needed an active opioid order. Patients were excluded if the opioid prescription came from an outside prescriber or if the patient was currently staying in a nursing home. Descriptive statistics were utilized for analysis of each required monitoring component. Data collected included informed consent, agreement to treat form, last urine drug screening (UDS), and last controlled substance monitoring database (CSMD) check prior to appointment date. Pharmacy student review of current medication list was used to identify the amount of benzodiazepine co-prescriptions, naloxone prescriptions, and total daily morphine milligram equivalence (MME). RESULTS/CONCLUSIONS: Data analysis is ongoing. Preliminary results identified 73 encounters that met criteria for audit. Reasonable congruence is expected with internal opioid policies which mirror state and national guidance on safe prescribing. It is anticipated to find need for minor improvement across most categories and significant opportunity to increase naloxone prescriptions. This study highlights the importance of opioid stewardship and proactively monitoring of site-specific policies.