Routine Opioid Outcome Monitoring (ROOM) in Community Pharmacy

Investigators: A/Prof Suzanne Nielsen, Pene Wood, A/Prof Raimondo Bruno, A/Prof Sarah Larney and Prof Alison Ritter

In Australia over the past decade, increasing harms have been attributed to prescription opioid use. This research study led by A/Prof Suzanne Nielsen aimed to develop and pilot the implementation of the Routine Opioid Outcome Monitoring (ROOM) in community pharmacies across NSW and Victoria, with the aim of improving identification of opioid-related problems as they emerge. The ROOM tool measures outcomes with opioids using a validated framework and includes domains such as pain, mood, opioid use disorder, alcohol use and constipation. The initial stage of the project developed and validated these tools for computer-based self-administered use. Next, ROOM was implemented with 64 pharmacists across 23 pharmacies who were recruited and trained to conduct ROOM. The screening processes were embedded into pharmacy dispensing software. Pharmacists also completed baseline and follow up surveys to measure changes in knowledge and confidence, following training and implementation.

Findings revealed significant improvements in confidence identifying and responding to unmanaged pain, depression and opioid dependence, from baseline to follow up. Pharmacists and patients also indicated the ROOM tool was acceptable in relation to ease of use, relevance and usefulness of the information provided. Pharmacist characteristics were associated with the degree of implementation of the ROOM, where fewer years of practice was associated with a greater number of screenings being conducted. Lower knowledge of naloxone and lower confidence in identifying unmanaged pain as baseline predicted with reduced engagement in screening with the ROOM tool in the study.

Project funded by the following sources: Central and Eastern Sydney Primary Health Network (CESPHN), Western Sydney Primary Health Network (WSPHN), NHMRC Translating Research Into Practice Fellowship and a Mindgardens Seed Funding Grant.

ROOM tool for patients

ROOM tool for health care professionals

OWLS tool for patients

OWLS tool for health care professionals

*These tools are best downloaded using a chrome browser.

Is there ROOM for improvement? Development and Outcomes of the Routine Opioid Outcome Monitoring study

Associate Professor Suzanne Nielsen presented at the 2020 NDARC Webinar Series on Thursday, 24 September 2020.

Room to improve? New tools: Routine Opioid Outcome Monitoring

Associate Professor Suzanne Nielsen presented at the Insight Centre for alcohol and other drug training and workforce development webinar on Wednesday, 31 October 2020.

Featured publications:

Nielsen S, Kowalski, Wood P, Larney S, Bruno R, Shanahan M, Lenton S, Dietze P, Green T, Murnion B & Ritter A. (2019) Routine Opioid Outcome Monitoring in Community Pharmacy: Pilot implementation study protocol. Research in Social and Administrative Pharmacy. 15(8):1047-1055. 10.1016/j.sapharm.2018.10.024

Nielsen, S, Picco, L, Campbell, G, Lintzeris, N, Larance, B, Farrell, M, Degenhardt, L & Bruno, R. (2020). Development of a Brief Patient-Administered Screening Tool for Prescription Opioid Dependence for Primary Care Settings. Pain Medicine, 21 (2), e79-e88. 10.1093/pm/pnz213

Nielsen S, Picco, L, Kowalski M, Sanfilippo P, Wood P, Larney S, Bruno R, Ritter A. (2020) Routine opioid outcome monitoring in community pharmacy: Outcomes from an open-label single-arm implementation-effectiveness pilot study. Research in Social and Administrative Pharmacy. 10.1016/j.sapharm.2020.02.009

Nielsen, S., Sanfilippo, P., Picco, L., Bruno R., Kowalski M., Wood P., Larney S. (2020) What predicts pharmacists’ engagement with opioid-outcome screening? Secondary analysis from an implementation study in community pharmacy. Int J Clin Pharm (2020). 10.1007/s11096-020-01074-5

Picco L, Middleton M, Bruno R, Kowalski M, Nielsen S. (2020) Validation of the OWLS, a Screening Tool for Measuring Prescription Opioid Use Disorder in Primary Care, Pain Medicine, pnaa275. 10.1093/pm/pnaa275

Picco L, Middleton M, Bruno R, Kowalski M, Nielsen S. (2020) Validation of the Routine Opioid Outcome Monitoring (ROOM) screening tool. Pain Medicine. 10.1093/pm/pnaa297