Step 3: Prevention
One important key to prevention is education that includes all team members who interact with residents as well as family members and the residents themselves. The pharmacist can play a key role here.
Russell added, “We need a team approach to identify and address each resident’s person-centered goals. We also need to talk with residents about nonpharmacologic interventions that may help their pain.” That means considering other, safe medications to treat pain as well as nonpharmacologic interventions such as physical therapy, nerve blocks, massage, or music therapy, when appropriate for a resident’s specific type and level of pain. At the same time, family members need to be educated about signs of addiction and respiratory depression to watch for and how to deliver naloxone in instances of an overdose.
Bose observed, “Medication management is sometimes a balancing act. It behooves us to be prioritize OUD prevention, rather than being gratuitous in our prescribing practices and
allowing OUD to occur and then seeking to treat it. We want to be responsible about opioid use, but we also need to be careful not to be punitive or stigmatizing against people who truly need opioid treatment to adequately manage their pain.”
It is helpful to have a qualified practitioner overseeing opioid stewardship efforts. This individual can take the lead on education, setting accountability standards, helping to ensure appropriate documentation, and making sure that processes are in place for appropriate dose reduction attempts and responsible prescribing practices. The pharmacist, said Bose, “can look at appropriate drug selection and dosages and provide a key perspective.”
“We need a team approach to identify and address each resident’s person-centered goals. We also need to talk with residents about nonpharmacologic interventions that may help their pain.”
Janis K. Russell, PharmD, MBA
Manager of Clinical Operations
PharMerica