The implementation date for ACP’s opioid guidelines is Oct 1, 2017. Since council approved these guidelines in June 2017, ACP has been working with pharmacists and various stakeholders to help facilitate the integration of the guidelines into practice.
The College of Physicians and Surgeons of Alberta (CPSA) implemented their Standard of Practice for Prescribing: Drugs with Potential for Misuse and Diversion for their members in April 2017. ACP guidelines were developed to align with these standards to ensure consistency and seamless patient care. There has been cooperation between ACP and CPSA and both colleges agree that collaboration among healthcare professionals is one of the keys to success. We have communicated to CPSA that both sets of guidelines will create more opportunities for inter-professional collaboration and that physicians may expect more contact from pharmacists after implementation.
We have already seen great examples of pharmacists approaching practitioners near to them and agreeing to pool resources and work together to help each other meet their respective standards and better serve the needs of their patients. If you have not done so already, consider proactively approaching the prescribers in your area to discuss this.
Start with Why
Many pharmacists are concerned that patients may find this pharmacist assessment to be intrusive. Bear in mind that pain and addiction are sensitive topics and the questions you ask can potentially make your patient uncomfortable. Ensure you assess and counsel in an area with suitable privacy and you take the time to explain to your patient why you are asking these questions and what the benefits are to their health. Explain to them that, with the ongoing opioid crisis, pharmacists are part of their healthcare team that works with their prescriber and other professionals to ensure they are getting optimal treatment for their condition. Although many people benefit from these medications, the risks are substantial and it is the pharmacist’s role to ensure that the medications use is both effective and safe.
From the guidelines, we should keep four goals in mind:
1) To ensure patients with acute pain are treated safely and appropriately and to avoid this treatment progressing to chronic use or misuse.
2) To manage patients using opioid medications chronically for pain to ensure adequate symptom control while monitoring for signs of misuse, or addiction.
3) For patients with identified addiction issues, to help direct them to appropriate resources.
4) To apply the principals of harm reduction and to avoid stigmatizing or judging patients requiring opiates or suffering from addiction.
Applying the principals of harm reduction doesn’t mean you condone or encourage an activity. Rather it means providing these individuals with respectful, non-judgmental care. This greatly reduces the risk of severe adverse outcomes while building trust with these individuals. For example, if you suspect an individual is misusing an opioid, regardless of your next steps, consider providing them with a Take Home Naloxone Kit.
We recognize that for many pharmacists, this falls outside of our comfort zone. Remember that ACP does not expect you to become a pain specialist or an addiction counselor. Rather, we do expect you to identify when issues exist that cannot be treated within the practice of pharmacy and to collaborate with or refer your patient to other healthcare providers, community services and/or appropriate addictions resources.
Everything Old is New Again
Another important point to remember is, although the opioid guidance document is new, the guidance statements are based upon our current standards of practice. The intent is simply to provide additional clarification to meet the standards in the context of patients using opioid medications and to ensure each one of these individuals obtains a thorough, meaningful assessment that is individualized to their needs.
When you examine how you currently assess and document for these patients, you may find that you already have much of this in place. If you identify gaps with your procedures, look at other systems you currently use, such as care planning software, that might assist in filling those gaps. Our practice consultants have already seen excellent, innovative examples of pharmacists developing or adapting processes and systems. Look for others within your organization or circle of colleagues that are having success and use these people as resources.
ACP remains committed to promoting excellence in patient care and we will continue to listen to your feedback and provide information and support up to the implementation date and beyond.
Originally published in the September 27, 2017, issue of The Link
- New guidelines for patients using opioid medications (July 6, 2017)
- Establishing professional relationships: exploring a new guideline for opioid medications (July 20, 2017)
- Why pharmacist assessment is critical to managing the opioid crisis (August 16, 2017)
- Assessing individuals using opioid medications: what you need to know (August 30, 2017)
- What are ACP’s expectations for documentation? Part 5 of our opioid guidelines series (September 13, 2017)
- Opioid Guidelines: are you ready for the October 1 implementation date (September 27, 2017)
- Message from the Registrar: Understanding the Opioid Guidelines (October 25, 2017)