Pharmacist-driven pain management service for patients at high risk for respiratory depression

Service or Program: Pharmacist-driven pain management service for patients at high risk for respiratory depression Justification/Documentation: Millions of Americans are affected by pain on a daily basis, and significant disparities exist in appropriate pain management – both in the inpatient and outpatient setting. Furthermore, opioid analgesics rank among the drugs most frequently associated with adverse drug events. In recognition of the nationwide epidemic of opioid-induced respiratory depression and over-sedation, The Joint Commission released Sentinel Event Alert #49 on the safe use of opioids that are prescribed and administered within the inpatient hospital setting. The Alert provides a number of evidence-based recommendations that can be taken to avoid the unintended consequences of opioid use among hospital inpatients, one of which is to create and implement policies and procedures for a second-level review of pain management plans with high-risk opioids by pain specialists or pharmacists. The primary objective of this service is to evaluate the effect of an inpatient pharmacist-driven pain management service and opioid stewardship on the number of respiratory depression and over-sedation cases, amount and types of opioids prescribed, patient pain scores and overall patient outcomes and satisfaction. Transferability: A pharmacist-driven service that offers the second-level review of pain management plans is a service that can be carried out in a variety of different care settings, particularly in the hospital acute-care setting. Impact: A pharmacist-driven pain management service offered to inpatients at high risk for respiratory depression can make a great impact on patient safety and satisfaction. Second-level review and optimization of pain medication regimens can reduce the incidence of opioid-related adverse effects such as over-sedation and respiratory depression, and improve patient outcomes and satisfaction.