Evidence-based Opioid Guidance in Acute Care: An Initiative for Advocating Provider Stewardship

Abstract

Introduction/Purpose: The purpose of this project was to improve providers’ knowledge and utilization of the Prescription Drug Monitoring Program (PDMP) and World Health Organization (WHO) pain ladder when prescribing opioid pain relievers in the inpatient setting. Methods: Fifteen providers, a mix of physicians and nurse practitioners, in the inpatient setting were recruited to participate in the project. The investigator provided one on one educational sessions regarding the utilization and importance of the PDMP and WHO pain ladder. Providers who have a Drug Enforcement Agency (DEA) license were eligible for participation while providers without a DEA license were excluded. Providers took a pre-test that measured providers’ perceptions on their knowledge regarding the PDMP and WHO pain ladder. Providers then received a brief online educational session regarding the importance of the PDMP and WHO pain ladder. Following the education sessions, providers were given six weeks to implement their knowledge regarding the utilization of the PDMP and WHO pain ladder into practice to see if it affects their prescribing behaviors of opioid pain relievers. After the six-week period, providers were sent a link to a post-education test that looked at their perception regarding knowledge gained during the project. Results: A total of 15 participants were recruited for the project at baseline. Ten providers completed the initial survey but failed to complete the pre and post-education surveys. Fifty percent (n=5) of the participants completed the project in full. The lack of participation is assumed to be due to the surge in COVID-19 cases when the project gained approval and began implementation. Of the five participants, three were nurse practitioners (60%) and two were physicians (40%). Data was analyzed by calculating pre and post test scores. The total score a participant could get was 90. The average score pre-education was 53 and the average score posteducation was 72. The project resulted in a 35% increase in knowledge. Discussion: This project implemented online education for providers regarding the PDMP/Narxcare™ and WHO pain ladder. The providers took a pre-education survey and posteducation survey. These surveys allowed providers to rate their knowledge of clinical practice guidelines, the PDMP/Narxcare™, and their assessment on whether or not they felt proficient in prescribing opioid pain relievers. The low provider participation rate was felt, in part, due to the unprecedented surge in community COVID-19 cases at the time of project implementation. Despite limitations and barriers, results showed providers perception regarding their knowledge of the PDMP, WHO pain ladder and opioid prescribing improved after six weeks. Additional studies with a large population are needed to determine if this education would benefit all providers and not just hospital-based ones.