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We are committed to supporting opioid stewardship initiatives

Fresenius Kabi supports leadership efforts for implementing hospital-wide opioid stewardship

One initiative of Opioid Stewardship is drug diversion. The availability of more precise clinically relevant vial and pre-filled syringe sizes may help address diversion by limiting the need for product waste and related documentation.1

According to the Institute for Safe Medication Practices, opioid stewardship may be described as “coordinated interventions designed to improve, monitor, and evaluate the use of opioids in order to support and protect human health.” 2

Opioid stewardship is a concept that emerged only recently and is modeled after the antimicrobial stewardship programs that have been widely implemented and are now required for Joint Commission-accredited hospitals and nursing care centers.3

Opioid stewardship in a hospital has been focused on discharge orders and prescribing of limited opiates, education, and establishing treatment protocols for OUD (opioid use disorder). Below are additional initiatives for consideration to improve pain management before surgical procedures.

Pain assessment and management standards

On January 1, 2018, The Joint Commission released its updated pain assessment and management standards. The requirements outline a multi-level approach to pain management to help frontline staff and clinicians deliver safe, individualized pain care. This page is designed to assist users in standard interpretation and provide resources on the topic of pain assessment and management.

Implementing ERAS protocols

Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery.

Administering multimodal strategies

A multimodal approach may decrease the use of opioids and associated side effects (e.g., delirium, and respiratory depression), tolerance, and diversion.4,5,6 Second, a multimodal approach may be a more effective pain control strategy, potentially decreasing the complications associated with suboptimal pain control, such as pneumonia, deep venous thrombosis, and postoperative cognitive dysfunction.4,5,6

Employing Perioperative Surgical Home

Perioperative Surgical Home is a patient-centric, team-based model of care created by leaders within the American Society of Anesthesiologists to help meet the demands of a rapidly approaching health care paradigm that will emphasize gratified providers, improved population health, reduced care costs, and satisfied patients.

Minimizing controlled substance waste streams

Waste may include products expiring, products prepared for administration but not administered to the patient (e.g., when a physician discontinues or a patient refuses administration), and drug product remaining after a partial dose is removed from its packaged unit.7 Controlled substances that are stocked in as ready-to-use form as possible7 and in optimal product sizes may help reduce medication waste.1

Addressing institutional drug diversion

Drug diversion can be defined as any criminal act or deviation that removes a prescription drug from its intended path.7 It is estimated that approximately 10% to 15% of all healthcare professionals will misuse drugs or alcohol at some time during their career.8 Controlled substances diversion in health systems can lead to serious patient safety issues, harm to the diverter, and significant liability risk to the organization.7 Optimizing product size may help minimize waste, risk of drug diversion, and costs accordingly.1

Reducing narcotic waste and related documentation (Case Study)

While pain control is an integral part of providing treatment to patients, doing so creates operational challenges for hospitals. Specifically, narcotic waste requires significant nursing time spent documenting. For example, one study (Hertig) estimated the amount of time each waste transaction requires is 76.2 seconds, not accounting for the waste witness (2nd RN) or pharmacy’s time to reconcile discrepancies. Additionally, each waste event opens the door for narcotic diversion.

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