Quality indicators to measure the effect of opioid stewardship interventions in hospital and emergency department settings

Rizk, Elsie; Swan, Joshua T.; Cheon, Ohbet; Colavecchia, A. Carmine; Bui, Lan N.; Kash, Bita A.; Chokshi, Sagar P.; Chen, Hua; Johnson, Michael L.; Liebl, Michael; Fink, Ezekiel

doi:10.1093/ajhp/zxy042

Cited by 22 publications

(23 citation statements)

References 24 publications

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“…Multimodal analgesia, or the use of multiple modalities of differing mechanisms of action, is key to decreasing surgical recovery times and complications, and so is also a fundamental component of the enhanced recovery paradigm promoted by the international Enhanced Recovery After Surgery (ERAS ® ) Society [19,24,[62][63][64][65]. Dedicated resources and care coordination are often required for institutions to align analgesic use with best practices, so Opioid Stewardship Programs (OSPs) are taking hold, modeled after antimicrobial stewardship practices [29,38,[66][67][68].…”

Section: Opioid Stewardship Multimodal Analgesia and Equianalgesic mentioning

confidence: 99%

“…As with nonopioid agents, oral opioids should be used preferentially over intravenous agents for patients who can utilize oral administration. The intravenous route does not confer superior efficacy and carries greater risk for adverse events, and should therefore be reserved for patients unable to use the oral route or patients with severe pain that is refractory to increased doses of oral agents [15,38,405]. When the intravenous route is intermittently warranted for severe breakthrough pain, healthcare provider administration of opioid doses according to patient-reported and functional pain assessments is typically adequate, especially for opioid-naïve inpatients.…”

Section: Postoperative Opioid Considerationsmentioning

confidence: 99%

“…Medication and patient safety issues abound with PCAs [408,409]. Accordingly, average duration of PCA use has been discussed as a quality indicator of hospital opioid stewardship practices [38]. Use of PCAs should be guided by institutional order sets with pre-built doses stratified for opioid-naïvety and risk for opioid-related respiratory depression, and continuous infusions should generally be avoided in opioid-naïve patients [15,71,408,409].…”

Section: Postoperative Opioid Considerationsmentioning

confidence: 99%

“…Avoiding concomitant sedatives, especially benzodiazepines, to all feasible extent is also an important modifiable risk for postoperative respiratory depression, sedation, and delirium. This is crucial in patients with higher baseline risks for this complications, including the elderly, obese, and those with preexisting lung disease [38,143,190,[447][448][449][450][451][452]. Specialized monitoring for patients receiving perioperative neuraxial opioids must be standardly executed and supported by institutional order sets as outlined elsewhere [15,453].…”

Section: Postoperative Opioid Considerationsmentioning

confidence: 99%

“…To this end, many organizations have offered guidance on components of their application. This has included general postoperative pain management [15][16][17], perioperative management of patients on preoperative opioids [18], surgery-specific guidelines [19][20][21][22][23][24], medication-specific recommendations [25,26], conceptual frameworks for opioid stewardship [27][28][29], collaborative postoperative opioid prescribing guidelines [30][31][32], statements on perioperative opioid use [33,34], legal opioid prescribing limits [35], and various quality measures for healthcare institutions [36][37][38]. Despite the multitude of recommendations available, a large proportion of surgical patients report inadequately treated pain and high rates of adverse events, alongside many institutions exhibiting overreliance on opioids and underutilization of multimodal strategies [2,39,40].…”

Section: Introductionmentioning

confidence: 99%

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Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

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Section: Opioid Stewardship Multimodal Analgesia and Equianalgesic mentioning

confidence: 99%

Section: Postoperative Opioid Considerationsmentioning

confidence: 99%

Section: Postoperative Opioid Considerationsmentioning

confidence: 99%

Section: Postoperative Opioid Considerationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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Development and testing of data infrastructure in the American College of Emergency Physicians’ Clinical Emergency Data Registry for opioid‐related research

et al. 2022

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Objective: Prior research has identified gaps in the capacity of electronic health records (EHRs) to capture the intricacies of opioid-related conditions. We sought to enhance the opioid data infrastructure within the American College of Emergency Physicians' Clinical Emergency Data Registry (CEDR), the largest national emergency medicine registry, through data mapping, validity testing, and feasibility assessment. Methods:We compared the CEDR data dictionary to opioid common data elements identified through prior environmental scans of publicly available data systems and dictionaries used in national informatics and quality measurement of policy initiatives. Validity and feasibility assessments of CEDR opioid-related data were conducted through the following steps: (1) electronic extraction of CEDR data meeting criteria for an opioid-related emergency care visit, (2) manual chart review assessing the quality of the extracted data, (3) completion of feasibility scorecards, and (4) qualitative interviews with physician reviewers and informatics personnel. Results: We identified several data gaps in the CEDR data dictionary when compared with prior environmental scans including urine drug testing, opioid medication, and social history data elements. Validity testing demonstrated correct or partially correct data for >90% of most extracted CEDR data elements. Factors affecting validity included lack of standardization, data incorrectness, and poor delimitation between emergency department (ED) versus hospital care. Feasibility testing highlighted low-to-moderate feasibility of date and social history data elements, significant EHR platform variation, and inconsistency in the extraction of common national data standards (eg, Logical Observation Identifiers Names and Codes, International Classification of Diseases, Tenth Revision codes).

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Fate of Cryptosporidium and Giardia through conventional and compact drinking water treatment plants

Moussa,

Ashour,

Soliman

et al. 2023

Parasitol Res

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Over the past three decades, a notable rise in the occurrence of enteric protozoan pathogens, especially Giardia and Cryptosporidium spp., in drinking water sources has been observed. This rise could be attributed not only to an actual increase in water contamination but also to improvements in detection methods. These waterborne pathogens have played a pivotal role in disease outbreaks and the overall escalation of disease rates in both developed and developing nations worldwide. Consequently, the control of waterborne diseases has become a vital component of public health policies and a primary objective of drinking water treatment plants (DWTPs). Limited studies applied real-time PCR (qPCR) and/or immunofluorescence assay (IFA) for monitoring Giardia and Cryptosporidium spp., particularly in developing countries like Egypt. Water samples from two conventional drinking water treatment plants and two compact units (CUs) were analyzed using both IFA and qPCR methods to detect Giardia and Cryptosporidium. Using qPCR and IFA, the conventional DWTPs showed complete removal of Giardia and Cryptosporidium, whereas Mansheyat Alqanater and Niklah CUs achieved only partial removal. Specifically, Cryptosporidium gene copies removal rates were 33.33% and 60% for Mansheyat Alqanater and Niklah CUs, respectively. Niklah CU also removed 50% of Giardia gene copies, but no Giardia gene copies were removed by Mansheyat Alqanater CU. Using IFA, both Mansheyat Alqanater and Niklah CUs showed a similar removal rate of 50% for Giardia cysts. Additionally, Niklah CU achieved a 50% removal of Cryptosporidium oocysts, whereas Mansheyat Alqanater CU did not show any removal of Cryptosporidium oocysts. Conventional DWTPs were more effective than CUs in removing enteric protozoa. The contamination of drinking water by enteric pathogenic protozoa remains a significant issue globally, leading to increased disease rates. Infectious disease surveillance in drinking water is an important epidemiological tool to monitor the health of a population.

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Quality indicators to measure the effect of opioid stewardship interventions in hospital and emergency department settings

Cited by 22 publications

References 24 publications

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Development and testing of data infrastructure in the American College of Emergency Physicians’ Clinical Emergency Data Registry for opioid‐related research

Fate of Cryptosporidium and Giardia through conventional and compact drinking water treatment plants

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