Perioperative pain management: Leveraging clinical pharmacist practitioners to improve opioid safety in veterans

Opioids are often indicated after orthopedic surgery, but guidance on how to incorporate patient-specific risks into opioid prescribing is limited, and overprescribing can place patients at risk. Pharmacists are known to enhance patient care in the ambulatory care setting but may be underutilized in the perioperative care setting.

The objectives of this retrospective multisite quality initiative (QI) project were to describe interventions by pain clinical pharmacist practitioners (CPPs) during perioperative visits and acceptance of recommendations by orthopedics teams. The secondary objectives included assessment of analgesic efficacy, describing opioid utilization and disposal, unplanned healthcare resource utilization or mortality at 30 days after surgery, and orthopedic team satisfaction with the service. Descriptive analysis was performed.

Over the course of 10 months, 289 patients undergoing orthopedic surgery received perioperative care by pain CPPs, for a total of 1,395 preoperative interventions and 624 postoperative interventions. Postoperative recommendations were accepted by the orthopedic teams 50% of the time. Nearly all team members agreed or strongly agreed that a CPP should become a permanent part of the team.

A CPP-run perioperative pain management clinic provides patient-specific pain management plans, opioid risk mitigation, and is well received by orthopedic teams.