Opioid Utilization and Management in the Setting of Stewardship During Inpatient Rehab Care

Laura Murphy,1– 3 Kori Leblanc,1,2,4 Souzi Badr,1,2 Emily Ching,1 Lynda Mao,1,2 Naomi Steenhof,1,2 Bassem Hamandi,1,2,4 Bonita Rubin,1,2 Ada Seto,1 Andrea D Furlan3,5,6 1Department of Pharmacy, University Health Network, Toronto, ON, Canada; 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; 3KITE Research Institute, University Health Network, Toronto, ON, Canada; 4Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; 5Department of Medicine, University of Toronto, Toronto, ON, Canada; 6Institute for Work & Health, Toronto, ON, CanadaCorrespondence: Laura Murphy, Department of Pharmacy, University Health Network, 550 University Ave, Toronto, ON, M5G 2A2, Canada, Tel +1 416-597-3422 x 3657, Fax +1 416-260-2658, Email laura.murphy@uhn.caBackground: Opioid utilization and management in an inpatient rehabilitation setting have not been widely described, despite the unique opportunities that exist in this setting to support opioid stewardship across transitions in care. We aimed to characterize opioid utilization and management by interprofessional teams across a large, inpatient rehabilitation setting after incorporation of opioid stewardship principles by pharmacists as part of their daily practice.Patients and methods: This was a retrospective chart review at Toronto Rehab, University Health Network, Toronto, Canada. Patients with admission orders for any opioid from November 2017 to February 2018 were included. Complex continuing care and palliative care patients were excluded. Descriptive statistics were primarily used to describe the data as well as univariate linear regression to compare associations with milligram morphine equivalent (MME) reduction.Results: A total of 448 patients were included. A reduction in total daily MME was seen in 49% (n=219) of the patients during their inpatient stay, with 73% (n=159) of these patients having a reduction of ≥ 50%. Sixty-nine percent (n=311) of the patients received an opioid prescription at discharge, with most scheduled (90%, n=98) with a supply of less than 30 days. Rehabilitation length of stay was correlated with a MME decrease during rehab (p< 0.01), suggesting that longer lengths of stay contributed to a greater reduction in MME. Patients with chronic opioid use prior to acute care admission (p=0.01), and those who started extended-release opioids during acute care (p=0.02) were significantly less likely to discontinue opioids during rehab stay.Conclusion: Opioid utilization and management in the setting of opioid stewardship across inpatient rehab and transitions of care were characterized. Opportunities exist for further quality improvement initiatives within inpatient rehabilitation and acute care settings to identify and support patients with complex pain management needs.Keywords: opioid, pain management, medication reconciliation, pharmacy practice, medication safety, discharge prescription