(1261) Impact of Pharmacist-Driven Opioid Stewardship on Oral Opioid Prescribing in Critically Ill Patients

Introduction: Patients frequently require opioids for analgosedation in the ICU. ICU patients are often prescribed unnecessary opioids at ICU and hospital discharge, leading to dependence, misuse, and death. Studies have not evaluated the ability for ICU pharmacists to mitigate this problem. This study aimed to determine if an ICU pharmacist-driven opioid stewardship program reduces prescribing of oral opioids across transitions of care in previously opioid-naïve adult ICU patients.

Methods: A pharmacist-driven opioid stewardship program was implemented in March 2021. Opioid-naïve patients admitted between April 2020-February 2021 were compared with patients admitted between April 2021-February 2022. Patients with an active oral opioid order in the ICU ≥72 hours were included and patients with an opioid prescribed prior to admission, history of medical marijuana use, transition to comfort care/hospice, death prior to discharge, pain service consultation, or admission during both time periods were excluded. Patient characteristics and inpatient opioid use/prescribing at ICU and hospital discharge were collected. Associations between outcomes by intervention group was evaluated using chi-square tests. A multiple logistic regression model was used for multivariate analysis.

Results: A total of 291 opioid-naive patients were included (192 pre-intervention and 99 post-intervention). Median lengths of stay were 10 days (ICU) vs 18 days (hospital). Patients had a median SOFA score of 5 and Charlson Comorbidity Index of 2. The median cumulative oxycodone equivalent dose while in the ICU was 93 mg. At ICU to floor transfer, 58.7% of patients were prescribed oral opioids, with no significant difference between pre- (59.9%) and post-intervention (57.6%) groups. At hospital discharge, 44.0% were prescribed opioids, with no significant difference between pre- (43.8%) and post-intervention (44.4%) groups.

Conclusions: No change was observed in the rate of oral opioid prescribing after implementation of an ICU pharmacist-driven opioid stewardship program. Further research is needed to identify interdisciplinary strategies to reduce unnecessary opioid prescribing at transitions of care.