Impact of pharmacists assisting with prescribing and undertaking medication review on oxycodone prescribing and supply for patients discharged from surgical wards

• Published in: Journal of clinical pharmacy and therapeutics Vol. 42; no. 5; pp. 567 - 572
• Main Authors: Tran, T., Taylor, S. E., Hardidge, A., Findakly, D., Aminian, P., Elliott, R. A.
• Format: Journal Article
• Language: English
• Published: England Hindawi Limited 01-10-2017
• Subjects: Adult; Aged; analgesics; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - supply & distribution; Consultation; discharge prescription; Drug Utilization Review - methods; Epidemics; Female; Humans; Male; Medical personnel; medication review; Middle Aged; Opioid-Related Disorders - prevention & control; Opioids; Oxycodone; Oxycodone - administration & dosage; Oxycodone - supply & distribution; Patient Discharge; Patients; Pharmacists; Pharmacists - organization & administration; Pharmacy Service, Hospital - organization & administration; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - statistics & numerical data; prescribing; Prescription Drug Overuse - prevention & control; Prescriptions; Professional Role; Prospective Studies; Retrospective Studies; surgery; medication review; pharmacists; discharge prescription; oxycodone; analgesics; prescribing; surgery
• DOI: 10.1111/jcpt.12540
• EISSN: 1365-2710
• ISSN: 0269-4727

Summary
What is known and objectives
Overprescribing of oxycodone is a contributor to the epidemic of prescription opioid misuse and deaths. Practice models to optimize oxycodone prescribing and supply need to be evaluated. We explored the impact of pharmacist‐assisted discharge prescribing and medication review on oxycodone prescribing and supply for patients discharged from surgical wards.
Methods
A retrospective audit was conducted on two surgical inpatient wards following a 16‐week prospective pre‐ and post‐intervention study. During the pre‐intervention period, discharge prescriptions were prepared by hospital doctors and then reviewed by a ward pharmacist (WP) before being dispensed. Post‐intervention, prescriptions were prepared by a project pharmacist in consultation with hospital doctors and then reviewed by a WP and dispensed.
Main endpoints were the following
Proportion of patients who were prescribed, and proportion supplied, oxycodone on discharge;
Median amount (milligrams) of oxycodone prescribed and supplied, for patients who were prescribed and supplied at least one oxycodone‐containing preparation, respectively.
Results
A total of 320 and 341 patients were evaluated pre‐ and post‐intervention, respectively. Pre‐intervention, 75.6% of patients were prescribed oxycodone; after WP review, 60.3% were supplied oxycodone (P<.01); the median amount both prescribed and supplied was 100 milligrams/patient. Post‐intervention, 68.6% of patients were prescribed oxycodone; after WP review, 57.8% were supplied oxycodone (P<.01); median amount prescribed and supplied was 50 milligrams/patient (difference in amount prescribed and supplied: 50 milligrams, P<.01).
What is new and conclusion
WP review of doctor‐prepared prescriptions reduced the proportion of patients who were supplied oxycodone but not the amount supplied/patient. Having a pharmacist assist with prescribing reduced the amount of oxycodone supplied.
This study evaluated the impact of pharmacist‐assisted discharge prescribing and pharmacist medication review on oxycodone prescribing and supply, for patients discharged from surgical wards. Pharmacist‐assisted prescribing reduced the amount of oxycodone (milligrams) prescribed and subsequently supplied. Pharmacist medication review at discharge reduced the proportion of patients supplied oxycodone.