Revision of a pharmacy teaching and learning curriculum to address resident, programmatic, and accreditation demands.

PROBLEM DESCRIPTION: Without externally validated tools to assess teaching and learning curriculum (TLC) programs, our program has undertaken continuous quality improvement (CQI) methods to make revisions in response to resident, programmatic, and accreditation demands. QUALITY IMPROVEMENT METHODS: Key stakeholders, including the college of pharmacy, the residents, and the executive committee, were engaged in discussion and feedback was solicited. RESULTS OF CQI INQUIRY: The demands identified prompted revision of the TLC teaching component, programming, and timeline. Major changes have included adding an application for the teaching track, limiting teaching track participation, altering the seminar format (to a mix of in person, virtual, and asynchronous), and starting the program earlier in the calendar year. Key stakeholders supported the proposed revisions. INTERPRETATION AND DISCUSSION: The CQI method summarized here worked well for the TLC. Although simplistic in nature, it met the needs of the TLC and engaged several stakeholders. No major challenges were encountered during the process and stakeholders were amenable to the process and proposed revisions. Given the lack of externally validated tools for assessing TLC programs, any TLC program could perform a similar CQI method to assist with revisions. CONCLUSION: Continuous quality improvement of the TLC to address resident, programmatic, and accreditation demands has been vital to optimize and sustain the program. Assessment will be ongoing as future revisions are made.

The impact of pain management changes to an inpatient general admission electronic order-set.

BACKGROUND: Opioids pose many risks, and standardized ordering processes need to be created. In May 2020, our institution implemented pain management changes to the inpatient general admission electronic order-set and increased provider education on pain management prescribing. OBJECTIVES: This study aimed to investigate the impact of pain management changes to the inpatient general admission electronic order-set on opioid prescribing. METHODS: Data were collected by retrospective chart review of 376 patients who were admitted using the inpatient general admission electronic order-set at 8 hospital locations within an integrated health system. Two cohorts were identified for comparison: patients admitted pre-electronic order-set change (n = 183; August 2019) and patients admitted post-electronic order-set change (n = 193; August 2020). The primary end points were the amount of intravenous (IV) opioids received measured in morphine milligram equivalents (MME), the quantification of opioids received for pain management, and the oral MME prescribed on discharge. RESULTS: There was no statistically significant difference in the use of IV opioids. There was, however, a statistically significant difference between the IV MME 24 to 48 hours with median 0 (interquartile range [IQR] 0, 6) and 0 (IQR 0, 0) for pre- and post-electronic order-set implementation, respectively (P = 0.003). Oxycodone was more frequently prescribed in the postimplementation cohort-55 patients (29%) compared with the 31 (17%) in the preimplementation cohort (P = 0.008). Tramadol was prescribed less frequently in the postimplementation cohort (n = 12 [6%]) than in preimplementation cohort (n = 28 [15%]) (P = 0.004). There was no statistically significant difference in the oral MME prescribed on discharge (P = 0.833). CONCLUSION: Changes to the inpatient general admission electronic order-set had relatively little impact on the prescribing of opioids. Further electronic order-set changes or other methodologies should be explored to affect inpatient opioid use.