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Prioritization of quality indicators for opioid stewardship

2019; Oxford University Press; Volume: 76; Issue: 19 Linguagem: Inglês

10.1093/ajhp/zxz163

1535-2900

Elsie Rizk, Joshua T. Swan, Ezekiel Fink,

Primary Care and Health Outcomes

We thank Drs. Oyler, Short, and Goree for their feedback and thoughtful review of our list of opioid stewardship quality indicators. The Houston Methodist Opioid Stewardship Program selected and prioritized quality indicators that were best suited to evaluate opioid stewardship interventions in hospital and emergency department settings. Of note, all quality indicators listed in our article and appendix were identified as being feasible and were deemed to have high or appropriate face validity by stakeholders. Only metrics with the highest priority rankings were retained in our list of 19 quality indicators. However, all of the quality indicators listed in the appendix may warrant additional attention in future studies or consensus processes. It is possible that our prioritization of quality indicators was influenced by local practices, healthcare culture, and information technology considerations that may not be fully applicable at other health systems. Quality indicator 25 related to e-prescribed opioid discharge prescriptions and is a very important metric to ensure safe and appropriate opioid use at discharge. Since our transition to allowing e-prescribing over a year ago, a substantial proportion of opioid discharge prescriptions are e-prescribed at Houston Methodist. Because a full list of discharge medications is entered in our electronic health record (EHR) for each patient, our stewardship program could easily access these EHR lists to track appropriateness of opioid discharge prescriptions that were printed or e-prescribed. Because our goal was to identify metrics that should be the target of future opioid stewardship interventions, our stakeholders assigned a higher priority to metrics focused on quantity and duration of opioids prescribed at discharge. However, determining whether or not a health system has the ability to allow for e-prescribing may be a valuable core element for evaluating opioid stewardship efforts among health systems.