Opioid prescribing in the emergency department of a tertiary hospital: A retrospective audit of hospital discharge data

Abstract

Objective EDs are a common source of prescription opioids on discharge. We explored opioid prescribing practices in an ED at a tertiary hospital in Victoria, Australia. Methods A retrospective audit over a 6 month period of patients discharged from the ED to the community with the maximum allowable quantities of prescription opioids. Results There was a total of 3301 patient‐episodes discharged with a prescription from the ED. Of these, 766 (23.2%, 95% confidence interval [CI] 21.8–24.6) were prescribed opioids, with over half discharged with the maximum allowable quantities of prescription opioids. Immediate‐release opioids were prescribed in 362 (85.8%, 95% CI 82.5–89.1) patient‐episodes, a combination of immediate‐release and slow‐release preparations were prescribed in 29 (6.9%, 95% CI 4.5–9.3) and 31 (7.3%, 95% CI 4.8–9.8) were prescribed as slow‐release opioids alone. Co‐prescription of other analgesia with opioids occurred in 152 (36.0%, 95% CI 31.4–40.6) patient‐episodes. Possible drug interactions between opioids and other medications were noted in 117 (27.7%, 95% CI 23.4–32.0) patient‐episodes. Discharge summaries were prepared for 360 (85.3%, 95% CI 81.9–88.7) patient‐episodes, but only 171 (40.5%, 95% CI 35.8–45.2) included a plan to address the opioids, be that an opioid‐weaning regimen, analgesia review or referral to a pain specialist on discharge. Conclusion Opioid prescribing was common in this ED, with almost one‐quarter of discharge prescriptions being for a prescription opioid. This audit highlights potential areas for practice improvement including review of the quantity of opioid tablets prescribed as well as an opioid plan on discharge from the ED.

Oxycodone prescribing in the emergency department during the opioid crisis

“…In our EDs however, over three-quarters of discharge prescriptions had no reduction in pack size, allowing for a maximum supply of tablets under the PBS to be dispensed. This rate of tablets per prescription is higher than previously reported both in Australia 10 and in EDs across the USA 12 during the height of the opioid crisis. This local practice is alarming and indicative that hospital prescribers may be giving insufficient consideration to the risks of iatrogenic opioid-related harm.…”

“…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.…”

Design and implementation of an electronic opioid management plan to support consistent communication of opioid analgesia prescribing intentions to patients and general practitioners

“…10 Of patients discharged from an Australian ED with 20 immediate-release or 28 slow-release opioid tablets, 40.5% had a discharge summary with an OMP. 3 This highlights that patients discharged with opioid prescriptions do not consistently have a documented OMP to facilitate post-discharge management in the community.…”

Continued opioid use following an emergency department presentation for low back pain

“…2,3 Opioid administration for low back pain is especially common in the ED where approximately two thirds of patients with low back pain receive opioids. 4,5 Although prescribing opioids on discharge from the ED is common in Australia, 6 it is not clear what proportion of low back pain patients receive an opioid analgesic prescription. Similarly, evidence on continued opioid use in low back pain patients after ED discharge is scarce.…”