2026 Southeastern Residency Conference

Impact of Pharmacist Education on Opioid Stewardship Interventions in a Community Hospital 
Authors: Malena Pontrich; Will Stewart
Background:
Opioid stewardship is an important component of patient safety and therapy augmentation. The 2022 CDC Clinical Practice Guidelines for Prescribing Opioids for Pain endorse the use of collaborative efforts among a variety of clinicians, including pharmacists, for integrated pain management. This study is designed to evaluate the impact of pharmacist education on the average number of opioid stewardship clinical interventions per month. Secondary outcomes will include monthly averages of patients discharged with naloxone prescriptions after an opioid stewardship intervention occurred, and average morphine milligram equivalents (MMEs) received per day while inpatient.
Methods:  
This retrospective study was approved by the local Institutional Review Board. Patients admitted to Baptist Health Lexington were included if they were over the age of 18 and had a pharmacist-led opioid stewardship intervention documented during their admission. Subjects were excluded if they were incarcerated patients, pregnant patients, hospice patients, enhanced recovery after surgery (ERAS) patients, or patients with patient-controlled analgesia (PCA). Clinical pharmacists received education on internal opioid stewardship workflow guidelines including possible opioid stewardship intervention types, appropriate use of opioid stewardship interventions, and documentation in the electronic health record. Baseline data on the number of opioid stewardship interventions, naloxone prescriptions at discharge, and average inpatient MMEs was collected from the electronic health record for the six months preceding the intervention, March 2025 through August 2025. The same data was collected for the six months after the education occurred, September 2025 through February 2026. The findings from the pre- and post-intervention stages will then be evaluated.
Results:
Among the 142 interventions included in the final study, 74 were in the pre-intervention group and 68 were in the post-intervention group. Among both groups the breakdown of intervention subtypes in the pre-intervention and post-intervention cohorts, respectively, is as follows: alternative therapy 9 (12.16%) vs 16 (23.53%, discontinuation of opioid 38 (51.35%) vs 31 (45.59%), dose change 13 (17.57%) vs 6 (8.82%), drug information/consultation 7 (9.09%) vs 3 (4.41%), initiation of naloxone 2 (2.70%) vs 6 (8.82%), none selected 5 (6.76%) vs 6 (8.82%). For the primary objective, the pre- and post-intervention average monthly number of opioid stewardship interventions was 12.33 and 11.33 (p = 0.50), respectively. For secondary objectives, the average number of naloxone prescriptions written at discharge per month was 0.7 before pharmacist education and 2.0 after pharmacist education (p = 0.03). The average number of MMEs administered per patient per day while admitted was 57.82 and 51.86 (p = 0.50) pre- and post-intervention, respectively.
Conclusions:
There was no statistically significant difference in the average number of opioid stewardship interventions documented per month in the pre- and post-intervention groups (p = 0.50). There was a statistically significant increase in the average number of naloxone prescriptions written at discharge (p = 0.03). There was no statistically significant difference in the monthly average of inpatient MMEs administered per patient per day (p = 0.50). Pharmacist education did not significantly impact the average number of opioid stewardship interventions or the average number of MMEs administered per patient per day. The average number of naloxone prescriptions written at discharge was significantly increased after pharmacist education on opioid stewardship workflow. Limitations include a small sample size, the exclusion of a large portion of the initial sample population after applying exclusion criteria, staff turnover, and variation in hospital census. Outpatient opioid doses and length of stay were also not accounted for when quantifying administered MMEs for patients which may have impacted results.