Effect of an emergency department opioid prescription policy on prescribing patterns

Chacko, Jerel; Greenstein, Josh; Ardolic, B.; Berwald, Nicole

doi:10.1016/j.ajem.2017.06.024

Cited by 23 publications

(32 citation statements)

References 3 publications

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“…These results are supported by other studies that consider the effects of departmental interventions on opiate prescribing . In the Australian context, one study found a brief one‐on‐one education session with ED prescribers decreased the overall amount of oxycodone prescribed to patients, increased information provided to patients, and increased communication to GPs regarding the opioid prescription .…”

Section: Discussionsupporting

confidence: 54%

Affecting emergency department oxycodone discharge prescribing: An educational intervention

Kline

Savage

Greenslade

et al. 2019

Emerg Medicine Australasia

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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.

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Section: Discussionsupporting

confidence: 54%

Affecting emergency department oxycodone discharge prescribing: An educational intervention

Kline

Savage

Greenslade

et al. 2019

Emerg Medicine Australasia

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“…Several of these studies have found that the publication of policies and guidelines have led to decreased rates of prescriptions that emergency clinicians provided for outpatient use. [11][12][13] Ghobadi et al 14 analyzed intravenous opioid ordering in a large, multi-ED, single health system before (2013) and after (2014) implementation of opioid prescribing guidelines and reported a 3.6% reduction. In addition, another study reported an intravenous morphine equivalent units (MEU) reduction with implementation of an opioid policy.…”

Section: Introductionmentioning

confidence: 99%

“…There have been multiple studies of the ED population that examine the rates of oral (PO) opioid prescriptions that are provided to patients for home use. Several of these studies have found that the publication of policies and guidelines have led to decreased rates of prescriptions that emergency clinicians provided for outpatient use 11–13 . Ghobadi et al 14 analyzed intravenous opioid ordering in a large, multi‐ED, single health system before (2013) and after (2014) implementation of opioid prescribing guidelines and reported a 3.6% reduction.…”

Section: Introductionmentioning

confidence: 99%

Opioid ordering habits in the acute emergency department visit: Before and after implementation of departmental prescribing guidelines

Maloy

Chen

et al. 2020

JACEP Open

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“…In patients who survive major trauma, chronic pain may be a significant problem in the years to come, requiring long‐term follow‐up . Also, prolonged opioid pain‐treatment in these patients may result in opioid abuse and major secondary health problems . Chronic pain can occur after the peripheral and central pain receptors are being sensitized in the acute phase due to release of inflammatory mediators .…”

Section: Introductionmentioning

confidence: 99%

Incidence of chronic pain 6 y after major trauma

Kolstadbraaten

Spreng

Wisloeff-Aase

et al. 2019

Acta Anaesthesiol Scand

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Background: Life saving measures is the main focus in the initial treatment of major trauma. In surviving patients, chronic pain may be a serious problem, but the long term incidence and potential risk factors are not very well studied. Methods:All adult trauma patients included in the institutional trauma registry in 2007 were assessed for eligibility. Among exclusion criteria were: Injury Severity Score < 9, endotracheal intubation before or during admission, spinal cord lesion, known chronic drug or substance abuse, major surgery within 3 h after admission. A patient questionnaire was sent out 6 y after injury focusing on frequency and intensity of pain. A subgroup analysis was done in patients with thoracic injuries, comparing patients with epidural analgesia (EDA) and patients without.Results: Sixty-eight patients were included in the study. Sixty-nine percent reported pain 6 y after injury and 24% had severe pain. The severity of the injury was a risk factor for development of chronic pain, whereas pain during initial hospital stay was not. In patients with thoracic injuries there was no correlation between initial treatment with EDA and decreased incidence of chronic pain, however patient numbers were small. Opioids were the main analgesics used initially; no patients received nonsteroidal anti-inflammatory drugs or peripheral nerve blocks during the first 24 h.Conclusion: Two thirds of the trauma patients had chronic pain 6 y after injury and one out of four had severe pain. The initial pain treatment was focused on opioids.

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Effect of an emergency department opioid prescription policy on prescribing patterns

Cited by 23 publications

References 3 publications

Affecting emergency department oxycodone discharge prescribing: An educational intervention

Affecting emergency department oxycodone discharge prescribing: An educational intervention

Opioid ordering habits in the acute emergency department visit: Before and after implementation of departmental prescribing guidelines

Incidence of chronic pain 6 y after major trauma

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