Pharmacists have been focusing on opioid assessments since the Guidelines for assessment and monitoring individuals using opioid medications came into effect on October 1, 2017.
Patient assessments are not a new requirement; they are an important element of the Standards of Practice for Pharmacists and Pharmacy Technicians (SPPPT). Specifically, Standards 3, 4, 5, and 6 address requirements of an assessment, and what to do if a drug-related problem is identified.
In the context of opioid therapy, pharmacists are further expected to meet the requirements outlined in the opioid assessment guidelines. They must complete a thorough assessment of anyone who is prescribed opioid medications or sold an exempted codeine product. Still, ACP’s pharmacy practice consultants are being asked to clarify how to meaningfully integrate opioid assessments into practice. Opioid therapy can be challenging for pharmacists to assess and monitor due to the complex nature of the underlying conditions and the risk of harm from the medications. This highlights the importance of a thorough assessment. The assessment assists in determining whether the medication is appropriate for the patient to meet their health needs, minimize harm, and reduce potential for dependence, misuse, addiction, and diversion.
Many pharmacists use the ACP Chat, Check, and, Chart tool to help frame their assessment processes. The ‘check’ portion of the tool involves four questions to assess whether a prescription is indicated, effective, and safe, and if the patient is adherent to therapy. Incorporating the vital behaviours identified in the Chat, Check, and Chart Vital to Patient Care tool can help to enhance assessments
Read the four points vital to patient care (below) through the lens of an opioid assessment. Consider how these vital behaviours could be used during an opioid assessment.
Connect with patients
Engage with the patient. Create and maintain a professional relationship and empower patients to become active partners in their health care. Remember that pain and addiction can be sensitive issues and it is important to build trust to avoid stigmatizing the patient or making them feel judged. Approaching patients from a position of genuine interest and care will help to build that trust. In an atmosphere of trust, patients will feel free to openly discuss their health history, which could result in a better pharmacist-patient relationship.
Confirm and document indication
Confirming the indication is a critical first step and will determine what the opioid assessment for each patient should look like. Assessments do not come in a one-size-fits-all format. For example, an assessment of a patient receiving a short-term opioid prescription following a tooth extraction will be much different from the assessment of a patient on long-term opioid therapy following a serious injury. Collecting information about the nature of your patient’s pain will assist you in determining what to focus on in your assessment.
Using Netcare routinely is essential for a better understanding of a patient’s health. A Netcare review must be part of each assessment, care plan, and follow-up of opioid therapy.
Depending on the specific patient scenario, you may wish to consider elements such as medication fill history or medication changes, relevant medical procedures, urine toxicology testing results, or hospitalizations related to pain or substance use.
In addition, Netcare can be an excellent tool for identifying other healthcare providers in the patient’s circle of care, in order to facilitate collaboration. After consulting Netcare, be sure to document relevant findings as part of your assessment.
Monitor patients / follow-up
The benefits of opioids can decrease with time while, simultaneously, the potential for harm can increase. This is why routine monitoring is so important, and pharmacists are in a good position to monitor long-term conditions such as chronic pain.
It can, however, be challenging to determine how to monitor someone’s pain. Some pharmacists say they struggle to assess patients when there are no relevant lab values or objective parameters to monitor. Focus on the patient’s health goals. Maybe they want to play with their grandkids more, but pain prevents that, or they are missing work, or they’ve lost the ability to carry out their daily living activities due to pain. Identifying functional parameters can be helpful in monitoring, and are more patient centred.
Once the initial assessment and treatment plans are completed, use future visits as an opportunity to monitor the treatment plan, see what’s changed, and follow up as needed. Think of it as adding to the existing plan, not creating a new one at each visit.
Remember, the guidelines were created to ensure that patients receive the most effective treatment for their condition, and to avoid adverse effects or drug-related problems.