Effect of pharmacist-led task force to reduce opioid prescribing in the emergency department

Abstract

Purpose Results of a study to determine the effect of a pharmacist-led opioid task force on emergency department (ED) opioid use and discharge prescriptions are presented. Methods An observational evaluation was conducted at a large tertiary care center (ED volume of 115,000 visits per year) to evaluate selected opioid use outcomes before and after implementation of an ED opioid reduction program by interdisciplinary task force of pharmacists, physicians, and nurses. Volumes of ED opioid orders and discharge prescriptions were evaluated over the entire 25-month study period and during designated 1-month preimplementation and postimplementation periods (January 2017 and January 2018). Opioid order trends were evaluated using linear regression analysis and further investigated with an interrupted time series analysis to determine the immediate and sustained effects of the program. Results From January 2017 to January 2018, ED opioid orders were reduced by 63.5% and discharge prescriptions by 55.8% from preimplementation levels: from 246.8 to 90.1 orders and from 85.3 to 37.7 prescriptions per 1,000 patient visits, respectively. Over the entire study period, there were significant decreases in both opioid orders (β, –78.4; 95% confidence interval [CI], –88.0 to –68.9; R2, 0.93; p < 0.0001) and ED discharge prescriptions (β, –24.4; 95% CI, –27.9 to –20.9; R2, 0.90; p < 0.001). The efforts of the task force had an immediate effect on opioid prescribing practices; results for effect sustainability were mixed. Conclusion A clinical pharmacist–led opioid reduction program in the ED was demonstrated to have positive results, with a more than 50% reduction in both ED opioid orders and discharge prescriptions.

Evaluation of Interventions to Reduce Opioid Prescribing for Patients Discharged From the Emergency Department

“…Of these, 180 were kept for full-text review, and 63 unique studies were included in the review ( Figure 1 ). 12 , 27 , 28 , 29 , 30 , 31 , 32 , 35 , 36 , 37 , 39 , 40 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , …”

“… 69 , 94 , 102 All studies were published within the last 10 years (2013 to 2021). Studies used mainly preintervention-postintervention (n = 39) 12 , 28 , 30 , 31 , 32 , 35 , 39 , 40 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 92 , 93 , 94 , 99 , 100 , 101 , 102 and ITS (n = 21) 27 , 29 , 36 , 37 , 54 , 55 , 56 , 57 , 71 , 72 , 73 , 74 , 87 , 88 , 89 , 90 , 91 , ...…”

“… 103 , 104 The EPG intervention was used to help reduce opioid prescriptions in 21 studies 31 , 32 , 35 , 36 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ; PDMP, in 19 studies 27 , 28 , 29 , 30 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 ; EMR-QC, in 11 studies 37 , 39 , 40 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 ; CPC, in 10 studies 12 , 86 , 87 , 88 , 89 , 90 , …”

Emergency Medicine Intern Education for Best Practices in Opioid Prescribing

“…An ED-focused opioid reduction program was developed and implemented in November 2017. 12 The program included opioid prescribing guidelines and evidencebased pathways for multimodal, stepwise pain management with opioid rescue for common ED disease states associated with moderate pain (musculoskeletal pain, back pain, renal colic, fractures, and headaches). The guidelines recommended morphine instead of hydromorphone or oxycodone for less euphoric effects, oral compared to intravenous opioids when possible, use of opioid agents alone compared to combination products (eg, opioid/ acetaminophen) for optimization of non-opioid adjuncts and more effective multimodal therapy, and no more than a three-day supply if prescribing opioids at discharge.…”

“…To evaluate the impact of this early education, we conducted a retrospective study comparing ED and discharge opioid-prescribing practices for the 2016 and 2018 intern classes (before and after the ED opioid reduction program/ education). Data on opioids prescribed for ED administration or at discharge, including medication name, dose, route of administration, directions, and number of tablets (for discharge prescriptions) was extracted from our EHR for two 12 We used intern schedules to identify shifts worked to calculate prescribing rate. A rate of opioids prescribed per shift was calculated for both ED opioid orders and discharge prescriptions.…”