Establishing an opioid stewardship leadership team, such as a committee or task force, within the health system is important. This team can help to raise awareness, strategize the top priorities for the organization, establish goals, and drive progress related to opioid stewardship.
Committees/task forces that are comprised of leadership or executives can be beneficial and will be able to:
- Provide top-down structure to legitimize opioid stewardship efforts,
- Provide high-level direction, organization, guidance for projects across the health system,
- Ensure opioid stewardship work across the health system is a priority,
- Encourage and facilitate collaboration on opioid stewardship, and
- Address challenges to making progress with opioid stewardship efforts. (Weiner, 2018)
Committees/task force membership should also include frontline staff (e.g., staff who are directly involved in providing care every day), who provide an on-the-ground perspective of the critical details and logistics necessary for the success of opioid stewardship activities.
The importance of establishing an opioid stewardship committee or task force is reflected in national quality, accreditation, and regulatory authorities’ recommendations or requirements to form a leadership team focused opioid stewardship:
In 2018 & 2019, the Joint Commission released new and revised Pain Assessment and Management Standards for hospitals, critical access hospitals, and ambulatory care organizations. Each standard has a similar new requirement that these organizations must have a leader or leadership team that is responsible for opioid stewardship-related activities.
Requirement – EP 1: The hospital has a leader or leadership team that is responsible for pain management and safe opioid prescribing and develops and monitors performance improvement activities.
Leadership responsibilities for developing and monitoring performance improvement activities specific to pain management and safe opioid prescribing
Whether an individual ‘leader’ is assigned this responsibility, or a ‘leadership team’ model is used, responsible leader(s):
- participate in defining the goals and metrics for performance improvement activities, e.g., on monitoring the use of opioids;
- allocate resources to conduct performance improvement activities;
- review performance improvement data;
- promote improvement in practices and accountability across disciplines and services involved in pain management and opioid prescribing
The Centers for Disease Control and Prevention (CDC) published a guide for implementing the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain which included guidance related to opioid stewardship committees or task forces.
If your practice or system has the resources and is able to create a change team, they can be responsible for the next steps, including implementing and monitoring the changes. The team should be interdisciplinary and should consist of leaders and staff. It is important to have clear roles for the champion and other change team members. Ideally, the team will include a range of roles, all of which will be involved in the change effort (e.g., medical directors, clinicians, nurses, medical assistants, pharmacists, behaviorists, clinical and/or front office staff managers, case workers). Consider representation from other key areas, such as IT, as many of the practice recommendations involve creating workflows within an EHR and pulling reports for clinical QI measures.” (CDC, 2018)In a 2020 publication focused on opioid stewardship measurement, the American Hospital Association (AHA) reiterates the Joint Commission requirements and offers the following considerations:
1. Executive leadership. Create an executive leadership team that includes chief medical or quality directors. Sponsorship from executive leadership demonstrates organizational priority and can assist when resources or funding is needed.
2. Multiple service lines/departments. Leaders with responsibilities across departments or service lines provide a broad line of sight, which helps organize and prioritize the work into a cohesive plan. Support for opioid stewardship must span the entire organization; an interdisciplinary approach is critical to gain fresh perspectives on your project and how it fits with your business strategy.
3. Project management. Setting the appropriate scope, schedule and budget improves your chances of achieving desired results. Efficient use of management tools ensures effective use of time and encourages forward momentum.
4. Information technology. This perspective is essential to provide insight into current capabilities and ease of data retrieval.
5. Legal or compliance. Useful given ever-changing regulatory requirements.
6. Patient advocates. They bring urgency to the work and convey critical but often unseen perspectives. Consider including representatives from Patient and Family Advisory Councils if available.”
(AHA, 2020)
In some rural healthcare settings, there may be fewer providers, staff, and/or resources. Many rural health teams have multiple commitments to existing committees related to other issues. One alternative to forming a large, new committee could be developing a small change team that reports out to, or is a sub-committee of, an existing committee (e.g., Medication Safety, Pharmacy & Therapeutics, Medical Staff Lead Committees, or even Quality Based/Patient Safety Committees).
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Listen to Audio Clip
Why a rural Wisconsin health system developed two opioid stewardship task forces
Clip from Podcast with Sarah Pagenkopf, Director of Pharmacy Services, Fort Health Care
Listen to Podcast
Full Interview with Sarah Pagenkopf, Director of Pharmacy Services, and Tyler Prickette, Clinical Pharmacist at Fort HealthCare discussing:
- efforts to get buy-in from leadership to establish opioid stewardship task forces
- description of task force composition and reporting structure
- charter document guiding opioid stewardship and the task forces
- logistics of running the opioid stewardship task forces
- factors that contributed to success of task forces, and
- advice for pharmacist colleagues in rural settings
