Affecting emergency department oxycodone discharge prescribing: An educational intervention

Abstract

Objective: To describe the impact of an educational intervention for ED prescribers on discharge oxycodone prescribing both for the number of oxycodone prescriptions per 1000 discharged patients, and the number of tablets per prescription. Secondary outcomes included the quality of general practitioner communication. Methods: An interrupted time series assessment was conducted in the ED of a tertiary referral hospital to establish the pre-intervention, periintervention and post-intervention prescribing profile of ED medical practitioners. Prescriber numbers were used to obtain drug data for all oxycodone-containing prescriptions from the Queensland Health Medicines Regulation and Quality Unit database. The intervention included education sessions, a staff information email, posters within the ED, and a patient brochure. It was conducted with relevant nurses, pharmacists and prescribing doctors. Results: In the pre-intervention period, 656/17 371 (38 per 1000) discharged patients were prescribed oxycodone, compared to 180/5938 (30 per 1000) during the intervention, and 602/20 505 (29 per 1000) post-intervention. This equated to a decrease of 8 per 1000 (95% CI 5-12 per 1000) and a 22% (95% CI 13-31%) relative prescribing reduction. The mean total number of tablets of oxycodone per prescription decreased from 16.7 (SD 16.5) preintervention, to 12.7 (SD 6.0) periintervention, to 10.7 (SD 5.2) postintervention. After the intervention, there was an increase in discharge communications to general practitioners by 15.4% (95% CI 9.7-21.1%). Conclusions: An ED prescribertargeted intervention reduced overall prescribing of oxycodone and improved communication at discharge. The prescribing intervention is one strategy that may be used by ED medical staff to improve patient safety and opioid stewardship in Australia.

Sociodemographic, clinical and pharmacological profiles of medication misuse and dependence in hospitalised older patients in Norway: a prospective cross-sectional study

“…According to both the Norwegian General Practice criteria (NORGEP) and international (Beers and the screening tool of older people's prescriptions (STOPP)) criteria27–29 and treatment guidelines,22 23 opioid analgesics, benzodiazepines and z-hypnotics are all classified as inappropriate drugs for older patients and should not be used on a long-term basis. Our findings are consistent with three studies previously conducted in Norway,6 16 30 and suggest that today’s prescribing behaviour is suboptimal and that more indepth research and educational interventions are needed 31 32…”

Oxycodone prescribing in the emergency department during the opioid crisis

“…This is equivalent to a supply of up to 9845 prescriptions for as many as 165 899 tablets, into the local community each year. While smaller single-centre audits 10,11 have previously identified a common practice of oxycodone discharge prescribing in local EDs, our incidence is almost double that reported in Australia by Kline et al 11 (38 per 1000 discharges). It is reassuring however to find that this behaviour in our health service remains significantly lower than reported in the USA during the height of the opioid crisis.…”

“…We suggest the provision of education for prescribers on the best practice use of opioids in acute pain, as well as the risks and public health consequences of these medications. Multiple educational interventions have been successful in reducing the incidence of oxycodone prescribing both within Australian and international EDs 15. Donaldson et al .…”

“…Multiple educational interventions have been successful in reducing the incidence of oxycodone prescribing both within Australian and international EDs. 11,14,15 Donaldson et al demonstrated that an education intervention as short as 5 min can improve the quality of patient education regarding opioids as well as notification to general practitioners of the commencement of this therapy. 14 Electronic prescribing software can also be utilised to encourage prescribing behaviour.…”

Safe Opioid Use, Storage, and Disposal Strategies in Cancer Pain Management

“…Efforts have also focused on educating medical providers with proper prescribing practices . In a cohort of patients after Cesarean section and thoracic surgery, investigators found that majority reported taking half or less of the prescribed medication (83% Cesarean section vs. 71% thoracic surgery) .…”