About Opioid Stewardship
The opioid epidemic continues to be a serious public health threat nationally. The primary evidence-based strategy to effectively address this crisis in our healthcare communities is a having a robust opioid stewardship program (OSP). To support provider OSP implementation efforts, HSAG has developed this resource site to provide guidance and information from safe and appropriate prescribing of opioids to navigating the complex issues associated with opioid use disorder (OUD). The following resources are categorized by the elements of opioid stewardship they support and include gap assessments, links to guidelines, webinars, and vetted evidence-based literature and toolkits.
Guidelines
- CDC—Guideline for Prescribing Opioids for Chronic Pain—United States, 2022
- CDC—Guideline for Prescribing Opioids for Chronic Pain Factsheet
- CDC—Creating a Culture of Safety for Opioid Prescribing: A Handbook for Healthcare Executives
- FDA—Blueprint for Prescriber Education for Extended-Release and Long-Acting Opioid Analgesics
SNF
- ADHS—Arizona Opioid Prescribing Guidelines
- ADHS—Preventing Overdose from a Hospital Setting
- Arizona Opioid Assistance & Referral (OAR) Line
- The Arizona Pain and Addiction Curriculum Clinical Resource Compendium 2019
- Arizona Guidelines for Emergency Department Controlled Substances Prescribing Full Report
- Arizona Opioid Action Plan Version 2.0
- OSP Evidence-Based Solutions to Consider for AZ Critical Access Hospitals
- HSAG OSP Gap Assessment | Specific Considerations for AZ Critical Access and Rural Hospitals
Commitment
- American Hospital Association—Opioid Stewardship Collaborative Action Plan Template
- American Hospital Association—Stem the Tide: Opioid Stewardship Measurement Implementation Guide (2020; p. 47)
- CDC—Video Series: Quality Improvement & Care Coordination When Prescribing Opioids for Chronic Pain
- CDC—Creating a Culture of Safety for Opioid Prescribing: A Handbook for Healthcare Executives
- NQF—Opioid Playbook (pp. 7–9)
- Society of Hospital Medicine—Reducing Opioid Events Guide (RADEO; pp. 7–8)
- The Joint Commission—R3 Report on Pain Assessment and Management Standards for Hospitals (pp. 1, 4)
- The Joint Commission Journal—An OSP System Success Story
SNF
- CDC—PDMP Fact Sheet
- CDC—Creating a Culture of Safety for Opioid Prescribing: A Handbook for Healthcare Executives
- CDC—Video Series: Quality Improvement & Care Coordination When Prescribing Opioids for Chronic Pain
- eCQI Safe Use of Opioids—Concurrent Prescribing (eCQM) Measure Specifications
- CDC—Implementing the CDC Guidline for Prescribing Opioids for Chronic Pain (pp. 6, 8, 10, 17, 23, 26, 27, 34, 41)
- A Health System–Wide Initiative to Decrease Opioid-Related Morbidity and Mortality
SNF
- AHA—Stem the Tide: Addressing the Opioid Epidemic
- Clinical Opiate Withdrawal Scale (COWS)
- CDC—Creating a Culture of Safety for Opioid Prescribing: A Handbook for Healthcare Executives
- Buprenorphine: An Overview for Clinicians
- Management of Opioid Use Disorder in the Emergency Department: A White Paper Prepared for the American Academy of Emergency Medicine (pp. 5–7)
- Support for Hospital Opioid Use Treatment (SHOUT) Webinar 6: Dishcarge Planning and ED Buprenorphine Induction
- CA Bridge Guide—Treatment of Substance Use Disorders in Association with COVID-19
- CA Bridge Guide—Acute Pain Management in Patients on Buprenorphine in ED and Critical Care
- HHS—Pain Management Best Practices (pp. 26, 65)
- Recommendations from the ERAS® Society for standards for the development of enhanced recovery after surgery guidelines
- Basics of Enhanced Recovery
- HSAG—Enhanced Recovery After Surgery (ERAS) and Managing the Difficult Patient
- AzMAT Mentors Program
Action
- The Office of the National Coordinator for Health Information Technology—Improving Opioid Prescribing through Electronic Clinical Decision Support Tools
- CDC—Creating a Culture of Safety for Opioid Prescribing: A Handbook for Healthcare Executives
- CDC Video Series: Quality Improvement & Care Coordination When Prescribing Opioids for Chronic Pain
- SHM RADEO Toolkit (Reducing Adverse Drug Events Related to Opioids Implementation Guide)
- CDC—Quality Improvement and Care Coordination: Implementing the CDC Guideline for Prescribing Opioids for Chronic Pain
- Safe Use of Opioids—Concurrent Prescribing (eCQM) measure specifications
- A Health System–Wide Initiative to Decrease Opioid-Related Morbidity and Mortality (pp. 4–5)
- CDC—Clinical Guidance for Selected Common Acute Pain Conditions
- Colorado ALTO Project
- ALTO Patient Pathways
- ALTO Program ED Clinical Applications (Innovation Award)—ALTO Protocols
- CDC—Prescription Opioids: What You Need to Know (Fact Sheet)
- CDC—Nonopioid Treatments for Chronic Pain (Fact Sheet)
- Geriatricpain.org—ALTO Nondrug Pain Management Overview
- Annals of Internal Medicine—Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians
SNF
- Rapid Opioid Dependence Screen (RODS)
- National Institute on Drug Abuse—Evidence-Based Screening Tools and Assessment Resource Materials
- AHA—Stem the Tide: Addressing the Opioid Epidemic (pp.15–18)
- Screener and Opioid Assessment for Patients with Pain (SOAPP)
- CDC—Creating a Culture of Safety for Opioid Prescribing: A Handbook for Healthcare Executives
- HSAG—Reducing Opioid Adverse Drug Events: Prescriber Tips and Preventing and Managing Opioid Side Effects
- U.S. Surgeon General’s Advisory on Naloxone and Opioid Overdose
SNF
- Bridge Program—Buprenorphine-Naloxone: What You Need to Know
- CA Bridge—MAT Options for Ongoing Treatment After Hospital Starts
- CDC—Creating a Culture of Safety for Opioid Prescribing: A Handbook for Healthcare Executives (pp. 14–15)
- CDC—Vital Signs: Opioid Overdoses Treated in Emergency Departments—Identify opportunities for action
- SAMHSA Treatment Locator
- AHCCCS Treatment Locator
- A Health System–Wide Initiative to Decrease Opioid-Related Morbidity and Mortality (p. 4)
SNF
Track and Report
- American Hospital Association—Stem the Tide: Opioid Stewardship Measurement Implementation Guide (2020)
- AMA—Help Save Lives: Co-prescribe Naloxone to Patients at Risk of Overdose
- CDC—Video Series: Quality Improvement & Care Coordination When Prescribing Opioids for Chronic Pain
- CDC—Implementing the CDC Guideline for Prescribing Opioids for Chronic Pain
- Safe Use of Opioids—Concurrent Prescribing (eCQM) Measure Specifications
- Prescribe to Prevent: Preventing Fata Opioid Overdose Among Your Patients
- NIH—Gudin et al (2013). Risks, Management, and Monitoring of Combination Opioid, Benzodiazepines, and/or Alcohol Use
- Sample Prescription & Dispensing Instructions for Nasal Naloxone with Tear-Off
- HHS—Naloxone: The Opioid Reversal Drug that Saves Lives
- FDA—Naloxone: Drug Safety Communication
SNF
- American Hospital Association—Stem the Tide: Opioid Stewardship Measurement Implementation Guide (2020)
- CDC—Creating a Culture of Safety for Opioid Prescribing: A Handbook for Healthcare Executives
- CDC—Clinical Quality Improvement Opioid Measures
- Safe Use of Opioids—Concurrent Prescribing (eCQM) measure specifications
- The Joint Commission Journal—An OSP System Success Story
- SHM RADEO Toolkit (Reducing Adverse Drug Events Related to Opioids Implementation Guide)
SNF
Education and Expertise
Risk Assessment
- National Institute on Drug Abuse: Evidence-Based Screening Tools and Assessment Resource Materials
- ISMP Medication Safety Self Assessment ® for High-Alert Medications
- Pasero Opioid-induced Sedation Scale (POSS)
- Screener and Opioid Assessment for Patients with Pain (SOAPP)
- Richmond Agitation Sedation Scale (RASS)
- The Pain Assessment and Management Initiative (PAMI) has a Discharge Planning Toolkit for Pain: Pain Management at Hospital Discharge
- SOS Risk Stratification Tool (p.77)
Pain Management
- American Pain Society—Guidelines on the Management of Postoperative Pain
- CDC—Implementing the CDC Guidline for Prescribing Opioids for Chronic Pain
- ACS Best Practice Guidelines for Acute Pain Management in Trauma Patients
- ACS Best Practice Guidelines for Acute Pain Management in Trauma Patients: Pain Management in Patients on Chronic Opioid Therapy or with Opioid Use Disorder
- PAMI Discharge Planning Toolkit for Pain
- Society of Hospital Medicine (SHM) Multimodal Pain Strategies Guide for Postoperative Pain Management
- CAMJ "Caring for Patients with Opioid Use Disorder in the Hospital"
SNF: Pain Management
- The Joint Commission—Pain Assessment and Management Standards for Nursing Care Centers (pp. 3–4)
- The Society for Post-Acute and Long-Term Care Medicine—Opioids in Nursing Homes Resolution and Position Statement
- ASCP—Opioid Stewardship Toolkit: A Pharmacist's Guide for Older Adults
- Geriatricpain.org—Education for Clinicians
Prescribing
- HSAG—Reducing Opioid Adverse Drug Events: Prescriber Tips and Preventing and Managing Opioid Side Effects
- CMS—2019 Medicare Part D Opioid Policies: Information for Prescribers
- FDA Blueprint for Prescriber Education for Extended-Release and Long-Acting Opioid Analgesics
- Opioids Prescribing Recommendation for Opioid-Naïve Patients
- Enhanced Recovery After Surgery (ERAS)
- HHS Opioid Tapering Guide
- Institute for Safe Medication Practices (ISMP) Targeted Medication Safety Best Practices for Hospitals
- CDC—Prescription Opioids: What You Need to Know (Fact Sheet)
- CDC—Promoting Safer and More Effective Pain Management (Fact Sheet)
- CDC—Nonopioid Treatments for Chronic Pain (Fact Sheet)
- Advocate for Opioid Recovery
- Sample Patient Agreement Forms
- Disposal of Unused Medicines: What You Should Know and Drug Takeback Program
- Pain: What to Expect and How to Manage at Home
- Managing Your Pain the Hospital
