An Integrative Review of Opioid Stewardship: Optimizing Patient Care and Safety with a Multidisciplinary Approach

Nicole Adams,1 Carol A Ott,2 Cody J Mullen,3 Yitong Wang4 1Purdue Regenstrief Center for Healthcare Engineering, West Lafayette, IN, USA; 2Purdue Department of Pharmacy Practice, West Lafayette, IN, USA; 3Purdue Department of Public Health, West Lafayette, IN, USA; 4Purdue School of Nursing, West Lafayette, IN, USACorrespondence: Nicole Adams, Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA, 47907, Email adams417@purdue.eduAbstract: The opioid crisis in the United States continues to take the lives of tens of thousands of Americans each year. Opioid medications are important components of acute pain management and opioid stewardship is necessary to mitigate opioid misuse while providing adequate pain control for patients with severe medical needs. The definition of opioid stewardship includes the use of evidence-based guidelines, policies, and patient-centered practices to promote appropriate prescribing, use, and deprescribing of opioids to optimize treatment and minimize adverse consequences. There is little concrete guidance about how to achieve these goals or define the role and importance of various healthcare professionals in opioid stewardship programs. An integrative review process was used to evaluate and collate best practices in opioid stewardship from a variety of published papers. The integrative review was chosen to be inclusive of papers outside of quantitative research, allowing for interpretation of qualitative research, position statements, reports, editorials, and opinions. Data extraction included 71 publications that revealed common characteristics that can improve and coalesce opioid stewardship programs. Top characteristics and themes developed include prescribing guidelines, patient and provider education, referral and consultation, prescribing audits, barriers to opioid stewardship, the use of multidisciplinary teams and non-physician healthcare providers, accountability, risk of misuse, access to care, and patient-centeredness. The use of electronic health record tools, decision support tools, patient screening and discharge standards, and opioid tapering were recommended. Open and consistent communication between patients and healthcare providers is deemed essential. Staffing resources were found to be a significant barrier to opioid stewardship. This integrative review of publications related to opioid stewardship seeks to provide a comprehensive list of best practices that can be incorporated into programs to streamline processes and contribute to an organized foundation that can be used in research to illuminate practices that lead to enhanced outcomes.Keywords: opioid, stewardship, multidisciplinary, education, patient-centered, barriers