Abstract: PUB288
Improving Opioid Utilization for Pain Management in Patients Suffering From CKD5 and ESRD
Session Information
Category: Pharmacology (PharmacoKinetics‚ -Dynamics‚ -Genomics)
- 1900 Pharmacology (PharmacoKinetics‚ -Dynamics‚ -Genomics)
Authors
- Castillo, Marcus, University of Miami School of Medicine, Miami, Florida, United States
- Bonanno, Charles, University of Miami Health System, Miami, Florida, United States
- Samiratedu, Michael M., University of Miami Health System, Miami, Florida, United States
- Nunez Sanchez, Aliercy, University of Miami Health System, Miami, Florida, United States
- Sosa, Marie A., University of Miami Health System, Miami, Florida, United States
Background
The use of morphine and codeine to treat pain in patients with CKD5 or ESRD has been associated with neurotoxic side effects due to the accumulation of drug metabolites secondary to impaired renal clearance and altered pharmacokinetics. Guidelines that offer physicians alternative treatment options with a safer side effect profile are essential. The goal of this project is to reduce the unnecessary use of these drugs in these patients at the University fo Miami Hospital (UMH).
Methods
A retrospective study was performed to determine the baseline metrics for how often morphine and codeine were prescribed to CKD5 and ESRD patients at UMH. From August 1st 2021 - January 31st 2022, data obtained from the Epic Electronic Medical Records showed that these opioids had been prescribed to this patient population a total of 532 times. Additionally, of 32 opioid related ADRs in 2021, 12 (38%) were seen in patients with renal dysfunction. Following a root cause analysis, the team detailed interventions to optimize treatment for these patients including: 1) offering brief educational materials 2) providing an evidence-based adapted WHO analgesic ladder with alternative treatment options, 3) creating physician and pharmacist electronic safety and best practice alerts (BPA) 4) initiating a daily report by the Opioid Stewardship for the prescription of these drugs in ESRD whereby pharmacists contact providers with recommendations.
Results
This quality improvement project is currently being implemented.
Conclusion
Following these interventions, we will analyze patient data to see if there has been a reduction in the overuse of these medications with the goal of reducing the number of opioid related ADRs from 38% to less than 10% in the 6 months following the PDSA cycle.
Figure 1. Codeine and Morphine Prescribed in CKD5 and ESRD at UMH 8/1/21 - 1/31/22.
Figure 2. BPA Safety Alert for the Prescription of Morhine in ESRD