Innovative Program Highlights Best Practices in Pain Management

By Tiffany Parnell
Sunday, November 1, 2015

Helping patients achieve safe, adequate pain relief is often challenging. Pharmacist-driven pain management programs may be one path to effectively addressing issues such as opioid safety and high medical costs.

In an Institute of Medicine report, “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research,” the Committee on Advancing Pain Research, Care and Education estimates chronic pain has a national, annual cost of $560 billion to $635 billion. Those alarming sums, coupled with the advent of a new era in health care that increasingly ties reimbursement to hospital readmission rates and patient satisfaction, underscore a need for better pain management practices.

A Wraparound Approach

In October 2013, Kaweah Delta Medical Center in Visalia, California, launched a Pharmacy Pain Management Service and Opioid Stewardship Program. The comprehensive program consists of a consultation service that assesses current pain management strategies and offers recommendations as necessary, as well as a component that helps identify patients at high risk for opioid-related adverse events and find solutions for them.

Three clinical pharmacists — Clint Brown, PharmD; Richard Poirier, PharmD; and Yleana Garcia, PharmD — staff the program and are available 10 hours a day, seven days a week for consultation. Each consultation includes a 15- to 30-minute meeting with patients and a complete verbal assessment of each patient’s pain. The consulting pharmacist then makes a recommendation, and if the patient’s physician accepts the recommendation, the pharmacist tracks the patient’s pain for at least 48 hours to ensure consistent management. After discharge, a member of the pharmacy team makes follow-up calls to answer questions and ensure patients are using their medications correctly.

“We become the physician extender and bridge the gap [between physicians and patients],” Brown says. “We get to spend more time with patients, which ultimately improves patient satisfaction.”

Documented Improvement

Patient response to the program has been overwhelmingly positive (see “Measures of Success”), but patients aren’t the only ones who see value. According to Poirier, the service initially averaged 15 monthly consultations. It now serves more than 40 patients per month. Nearly 90 percent of the recommendations the pharmacists make are adopted by physicians, and physicians and nurses have also taken advantage of both informal and formal educational opportunities provided by the pharmacy team.

With a growing understanding that pain is highly specific to each patient — and can be exacerbated by myriad social factors as well as psychological distress — pharmacists may have unique insights into identifying the root causes of pain and the most effective interventions.

“Pain, as the ‘fifth vital sign,’ is treated as a number, which does not characterize pain or help guide appropriate treatment selection,” Garcia says. “This should not take the place of a proper pain management assessment. The phrase ‘Don’t treat the number, treat the patient’ should also be applied to pain management principles. Pain is much more than a number.”

Measures of Success

According to Clint Brown, PharmD, clinical pharmacist at Kaweah Delta Medical Center, the center observed the following results within only nine months of the Pharmacy Pain Management Service and Opioid Stewardship Program’s October 2013 launch:

  • A 59 percent reduction in rapid response and code blue calls due to opioid use
  • A 7 percent reduction in high-dose, IV parenteral hydromorphone (Dilaudid) usage; trends in usage dropped from 2 to 4 mg of IV parenteral hydromorphone usage to 0.5 to 1 mg of IV drug usage.
  • A nearly 20 percent reduction in the number of patients prescribed a fentanyl patch
  • Approximately 1,300 interventions, which netted literature-supported, indirect cost savings of roughly $1.6 million

Since the program’s launch, patient satisfaction scores, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), that look both at how well pain is controlled and whether patients perceive that their medical team did everything possible to control pain have risen from averages in the 60th percentile to averages in the 70th and low-80th percentiles. According to Medicare’s Hospital Compare, which is compiled using HCAHPS data, 71 percent of patients who received care at Kaweah Delta Medical Center reported that their pain was always well-controlled during their hospital stay.

Doc Writing Script 750