Woods Brendan, Legal Michael, Shalansky Stephen, Mihic Tamara, Ma Winnie
, BScPharm, ACPR, is a Clinical Pharmacist with Royal University Hospital, Saskatchewan Health Authority, Saskatoon, Saskatchewan.
, BScPharm, PharmD, ACPR, FCSHP, is Clinical Pharmacy Manager with Lower Mainland Pharmacy Services, Vancouver, British Columbia.
Can J Hosp Pharm. 2020 Jan-Feb;73(1):7-12. Epub 2020 Feb 1.
Despite the recent increase in opioid overdoses across Canada, few pharmacy-led initiatives have been implemented to address issues related to opioid prescribing in the hospital setting.
The primary objective of this study was to develop a clinical tool, intended for use by hospital pharmacists and informed by best practices from the literature, that would provide a structured approach to enhancing the safety of opioid prescribing. The secondary objective was to collect pharmacists' opinions about the feasibility and utility of this tool.
A comprehensive literature search and pharmacist focus group analysis provided content for development of a candidate clinical tool. This tool was then piloted by clinical pharmacists working on general medical and surgical units in a single hospital. Pharmacists participating in the pilot were invited to complete an online survey concerning their perceptions of the tool. Descriptive statistics were used to analyze the survey results.
The literature search and focus group analysis led to development of a candidate clinical tool that focused on Medication review, Optimization, Reassessment, and Education (MORE). It included key risk factors relating to opioid safety, along with suggested mitigating strategies. The MORE tool was piloted for 3 weeks by 14 clinical pharmacists, 9 of whom responded to the subsequent survey. Five respondents indicated that the clinical tool increased their ability to identify risk factors. Five respondents also noted an increase in their ability to identify possible interventions. Most respondents felt that the tool was useful and that it would be feasible to integrate it into their practice; however, they noted that a more streamlined version could improve ease of use.
The MORE tool was well received by clinical pharmacists. Implementation of the tool into routine practice requires additional changes to improve ease of use. Suggestions for modifying and streamlining the tool will be incorporated into future versions.
尽管近期加拿大阿片类药物过量使用情况有所增加，但在医院环境中，由药房主导的旨在解决与阿片类药物处方相关问题的举措却很少。
本研究的主要目的是开发一种临床工具，供医院药剂师使用，并以文献中的最佳实践为依据，该工具将提供一种结构化方法来提高阿片类药物处方的安全性。次要目的是收集药剂师对该工具的可行性和实用性的意见。
全面的文献检索和药剂师焦点小组分析为候选临床工具的开发提供了内容。然后，该工具由一家医院普通内科和外科病房的临床药剂师进行试点。邀请参与试点的药剂师完成一项关于他们对该工具看法的在线调查。使用描述性统计分析调查结果。
文献检索和焦点小组分析导致开发了一种候选临床工具，该工具侧重于药物审查、优化、重新评估和教育（MORE）。它包括与阿片类药物安全相关的关键风险因素以及建议的缓解策略。14名临床药剂师对MORE工具进行了为期3周的试点，其中9人对随后的调查做出了回应。5名受访者表示，该临床工具提高了他们识别风险因素的能力。5名受访者还指出，他们识别可能干预措施的能力有所提高。大多数受访者认为该工具很有用，并且将其整合到他们的实践中是可行的；然而，他们指出，更简化的版本可以提高易用性。
临床药剂师对MORE工具评价很高。将该工具应用于常规实践需要进行更多更改以提高易用性。修改和简化该工具的建议将纳入未来版本。
