Minimizing opioid use after acute major trauma

Oyler, Douglas R.; Bernard, Andrew C.; VanHoose, Jeremy; Parli, Sara E.; Ellis, Carleton S.; Li, David; Procter, Levi; Chang, Pei Ching

doi:10.2146/ajhp161021

Cited by 21 publications

(28 citation statements)

References 17 publications

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“…A study of inpatient opioid use found that the proportion of patients receiving slow release opioids declined from 35% to 16% following an education intervention, and that of patients discharged without opioids increased from 9% to 13%. 21 Other studies have reported that prescribed daily opioid doses declined by one-half following educational interventions. 20,22 The reductions in our study were less pronounced, but the median baseline dose was lower (30 mg daily oral morphine equivalent) than in previous studies (150 mg, 20 90 mg 21 ).…”

Section: Discussionmentioning

confidence: 99%

“…21 Other studies have reported that prescribed daily opioid doses declined by one-half following educational interventions. 20,22 The reductions in our study were less pronounced, but the median baseline dose was lower (30 mg daily oral morphine equivalent) than in previous studies (150 mg, 20 90 mg 21 ). Similarly, the reductions in quantities supplied were not as pronounced as in previous studies, 20,22,24 but the baseline quantities were also lower in our study; this is unsurprising, as opioids are now prescribed in smaller quantities because of growing awareness of the potential harms and poor functional outcomes associated with their long term use.…”

Section: Discussionmentioning

confidence: 99%

“…[17][18][19] Studies examining prescribing have focused on specific patient groups (eg, outpatients or patients with chronic pain), have evaluated limited selections of opioids, and have often not distinguished between slow and immediate release formulations or between opioid-naïve and opioidtolerant patients, limiting the generalisability of their findings. [20][21][22][23][24] Participants: Opioid-naïve patients discharged from surgical units after a stay of at least 24 hours.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Educating junior doctors and pharmacists to reduce discharge prescribing of opioids for surgical patients: a cluster randomised controlled trial

Hopkins

Bui

Konstantatos

et al. 2020

Medical Journal of Australia

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Educating junior doctors and pharmacists to reduce discharge prescribing of opioids for surgical patients: a cluster randomised controlled trial

Hopkins

Bui

Konstantatos

et al. 2020

Medical Journal of Australia

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“…Given the conjoined priorities of appropriately treating severe pain during ICU/hospital stays and ameliorating opioid overuse and abuse, it is not surprising that efforts by hospitals to control the opioid epidemic have focused on limiting inappropriate opioid prescribing at patient discharge, since prescribing at discharge has been shown to contribute to chronic opioid use in opioid‐naïve patients . Furthermore, data from the CDC demonstrates that approximately 10% of fatal overdoses occur in patients released from institutional settings in the month preceding the overdose .…”

Section: Implications Of the Opioid Epidemic For Critical Care Practimentioning

confidence: 99%

Implications of the opioid epidemic for critical care practice

Erstad

2018

J Am Coll Clin Pharm

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The purpose of this paper is to consider the implications of the opioid epidemic for the critical care practitioner and provide recommendations to try to reduce the likelihood of opioid over‐prescribing. The medical literature pertaining to the current opioid epidemic has focused on opioid overdose and deaths associated with the chronic use of opioids, but the issue has implications for the critical care pharmacist because excessive prescribing during hospitalization and at discharge may lead to chronic use. Guidelines are available concerning pain assessment and control in the critical care setting, but the evidence base supporting these recommendations is limited and often based on extrapolations from postoperative pain studies. While current pain management guidelines pertaining to critically ill patients place more emphasis and recommendations on nonopioid agents as adjuncts to opioids for severe pain, the recommendations for these adjuncts are tempered by a lack of higher‐level evidence supporting their use and concerns related to adverse effects. Efforts to control opioid over‐prescribing begin in the intensive care unit (ICU) with implementation of recommendations from current clinical practice guidelines that recommend appropriate assessments. After the ICU stay, attention should be focused on prescribing practices associated with patients' transition of care from hospital to home or other care facility, because this is where acute‐to‐chronic use is most likely to occur. Clinical pharmacist involvement in follow‐up clinics postdischarge has the potential to improve patients' pain control by optimizing medication use.

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“…A literature search has identified efforts in multiple disciplines where pain control has been improved for trauma inpatients. Multiple modes of analgesia have been shown to improve acute pain control6 and targeting prescriber education has been demonstrated to improve practice 7…”

Section: Introductionmentioning

confidence: 99%

Improving analgesia prescription for trauma inpatients

et al. 2018

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Patients value effective pain relief. Complications of inadequate pain control include increased risk of infection, decreased patient comfort and progression to chronic pain, all of which have significant socioeconomic consequence. Accessibility to analgesia is vital to effective administration. This improvement project aimed to improve the consistency and adequacy of analgesia prescribing for trauma inpatients over a 12-month period. Four PDSA (‘plan, do, study, act’) cycles resulted in sustained and significant improvements in analgesia prescription. The interventions included senior encouragement, teaching sessions, targeted inductions and implementation of a novel e-prescribing protocol. Prospective data and real-time discussion from stakeholder medical and management teams enabled iterative change to practice. Drug charts were reviewed for all trauma inpatients (n=276) over a 10-month period, recording all analgesia prescribed within 24 hours of admission. Each prescription was scored (maximum of 10 points) according to parameters agreed by the acute pain specialty leaders. An improving trend was observed in the analgesia score over the study period. Each intervention was associated with improved practice. Based on observed improvements, a novel electronic prescribing protocol was developed in conjunction with the information technology department, resulting in maximum scores for prescribing which were sustained over the final 3 months of the study. This was subsequently adopted as standard practice within the department. One year following completion of the project, a further 3 weeks of data were collected to assess long-term sustainability—scores remained 10 out of 10. Addressing the prescribing habits of junior doctors improved accessibility to analgesia for trauma patients. The electronic prescribing tool made prescribing straightforward and faster, and was the most successful intervention. Doctor satisfaction using this time-saving tool was high. Identifying a stakeholder within the information technology department proved pivotal to transferring the project aims into clinical practice.

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Minimizing opioid use after acute major trauma

Abstract: Targeted provider and patient education on minimizing opioid use was associated with a reduction in MME on discharge from the hospital after traumatic injury.

Cited by 21 publications

References 17 publications

Educating junior doctors and pharmacists to reduce discharge prescribing of opioids for surgical patients: a cluster randomised controlled trial

Educating junior doctors and pharmacists to reduce discharge prescribing of opioids for surgical patients: a cluster randomised controlled trial

Implications of the opioid epidemic for critical care practice

Improving analgesia prescription for trauma inpatients

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