Dr. Tran was a PGY-2 Pain/Palliative Care Pharmacy Resident at the time this article was written, Dr. DiScala is a Clinical Pharmacy Specialist for Pain/Palliative Care/Geriatrics, Dr. Forbes is a Clinical Pharmacy Supervisor, Dr. Brooks is a Clinical Pharmacy Specialist for Pain Management, Dr. Meléndez-Benabe is Chief of Chronic Pain Management, and Dr. Cuevas-Trisán is the Chief of Physical Medicine and Rehabilitation, all at the West Palm Beach VAMC in Florida. Currently, Dr. Tran is a Pain/Palliative Care Pharmacy Specialist at Florida Hospital in Orlando.
Acknowledgments A special thank you to Joyti Sharma, MD, of the Pain Management Department at the West Palm Beach VAMC for her meaningful contributions in ensuring the success of the inpatient pain pharmacy consult service. She not only helped to review this manuscript, but also offered her invaluable expertise and assistance with some of the more challenging consult requests, including those that needed referral to pain physicians for interventional procedures. No compensation was provided for Dr. Sharma’s contributions.
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner , Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
Future Directions
Future efforts to expand this project include ensuring patient safety through judicious opioid use. Smooth transitions of care will particularly help to improve the quality of pain management. Current WPBVAMC policies stated that the primary care provider (PCP) alone must agree to continue prescribing outpatient analgesic medications, including opioids, prescribed from the OCPC once patients return to Primary Care. Continued provider education would ideally promote efficient utilization of the IPPCS and OCPC.
The pain pharmacy SOAR note template also could undergo additional edits/revisions, including the addition of opioid overdose risk assessments. For improved documentation and standardization, the template could autopopulate patient-specific information when the inpatient pain CPS chooses the designated note title. The IPPCS also hoped to streamline the CPRS consult link for more convenience and ease of use. Ultimately, the IPPCS wished to provide ongoing provider education, inpatient opioid therapy, and other topics upon request.
Conclusion
The IPPCS received positive provider feedback and collected 100 consults (averaging 4 per week) during the 6-month pilot QI project. Most consults were for acute or chronic pain and requested nonopioid/adjuvant recommendations. The new service intended to fulfill unmet needs at the WPBVAMC by expanding the facility’s current pain programs. Prescribers reported a high level of satisfaction and a willingness to not only refer other clinicians to the program, but also continue using the consult. Providers unanimously agreed that the pain CPS provided reasonable, evidence-based recommendations. This project demonstrated that the IPPCS can aid in meeting new demands amid the challenging landscape of pain practice.
