15 - Retrospective Chart Review of Advanced Practice Pharmacist Prescribing of Controlled Substances for Pain Management in Veterans

Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA

Purpose
The objective of the retrospective chart review project was to identify the impact of an advanced practice pharmacist with controlled substance prescriptive authority on morphine milligram equivalent dose (MME) and compliance with opioid risk mitigation.
Methods
This was a retrospective, single-center chart review conducted in March 2020 of patients prescribed controlled substances from July 2018 – January 2020. Patients received care through the outpatient Pharmacy Pain Clinic in-person or via telephone who were enrolled at the Harry S. Truman Memorial Veterans’ Hospital in Columbia, MO or associated outlying outpatient clinics. Patients were included if referred to the Pharmacy Pain Clinic and prescribed a schedule II or III opioid medication. A two-sided t-test was conducted to compare MME and a Fisher’s exact test was used to compare compliance with opioid risk mitigation.
Results
Patients seen in Pharmacy Pain Clinic had a statistically significant reduction in MME from consult (93 MME) to discharge (31 MME) (p<0.0001). There was also a statistically significant (p<0.0001) improvement in use of opioid risk mitigation strategies including urine drug screen, informed consent, naloxone, prescription drug monitoring program checks, and stratification tool for opioid risk mitigation (STORM) dashboard reviews.
Conclusions
An advanced practice pharmacist with controlled substance prescriptive authority improved patient care with demonstrated statistically significant differences in MME and compliance with opioid risk mitigation from consult to discharge. Healthcare teams should look to add advanced practice pharmacists to their team as medication experts to deliver comprehensive medication management which can include controlled substance prescribing and management.