Opioid Stewardship Program Sets Standard for Compassionate Care

CHI Saint Joseph Health is expanding the Opioid Stewardship Program, established at Saint Joseph Hospital in 2019, to the ministry. The program provides a pharmacy consultation service to patients who are admitted with issues related to opioid use disorder. It addresses the holistic needs of a vulnerable patient population to help curb use of opioids as part of the care plan and encourages and supports patients to receive assistance outside of the hospital. 

“One of the first things we did was create a pain management and addiction medicine consult service in Lexington,” said Haley Busch, Pharm.D. “We see patients at the bedside. We have conversations about what the guidelines recommend for starting medications for opioid use disorder (MOUD), and we want to offer compassionate, comprehensive treatment.”

The Community Health Needs Assessment identified hospitals as a frontline resource for addressing opioid use disorder. During the pilot for implementation for the new consultation service, the program saw a significant decrease in pain levels among participating patients. Some measures of this included reducing the amount of opioids prescribed and reducing the co-prescription of opioids and benzodiazepines. The pilot program demonstrated how providers can effectively limit use of opioids as part of pain management practices. It also helped patients who suffered from opioid use disorder find a better way to manage their pain and begin recovery efforts. 

The pilot consultation service program tracked data since 2019 to identify improvements in the consult service and educational efforts. That led to the introduction of evidence-based practices and educational opportunities with a goal to decrease the use of prescription opioids in a hospital setting and help patients connect with community resources for outpatient treatment.  

“We’ve created an order set for starting an MOUD called buprenorphine, so now providers can easily order medications, and there’s an embedded consult for pharmacy and case management to support the patient’s needs,” Busch said. 

Some 93% of providers and physicians completed a training course to learn more about opioid stewardship during the last year.

“Our goal was to provide education to at least 90% of our providers,” Busch said. “We achieved that, and had many nurses and case management team members complete the educational training, too.”

Busch said hospitals in Lexington have also seen an increase in the number of buprenorphine prescriptions on both the inpatient and outpatient side, which is an evidence-based, medication-driven strategy that has been shown to significantly reduce opioid-related overdose and death at a higher rate than any other treatment strategy. During discharge, Busch continues to advocate for patients to continue their MOUDs through outpatient centers, a critical step on the road to recovery. Seeing victories for any of her patients is inspiring for Busch.

“This is not always the case, but if you have a win every six months, that’s enough to keep going and this is an example of that: We had a patient come in with sepsis secondary to endocarditis that was caused by IV drug use,” Busch said. “I had a consultation with this patient and we talked about which options they should take because their prognosis looked bad. We had a very honest yet compassionate conversation about really making a lifestyle change and starting MOUDs and psychosocial interventions.”

Busch said the patient was open and willing to begin MOUDs with her support. Busch said the patient asked for their mother to come and support their journey. 

“The patient’s mother said this was the first time [the patient] was treated like a human who had a disease that is treatable and not just an addict,” Busch said. “This was one of the most rewarding and humbling experiences I’ve had in my career so far.” 

Busch said she saw the patient again more than a year later. That patient had become a peer support specialist helping others on their journey to recovery.