Safe Opioid Prescribing at Discharge

Safe Opioid Prescribing at Discharge Taylor Goodman, PharmD; Elva Van Devender, PharmD; Luetta Jones, PharmD; Courtney Barber Background/Purpose: The opioid epidemic has led to devastating consequences, especially in Oregon, with an average of five Oregonians dying each week from opioid overdose. Opioid prescriptions at discharge are correlated with future continued opioid use. United States providers prescribe more opioids both inpatient and at discharge than other countries, and Oregon providers wrote more opioid prescriptions per person than the national average. Oversupplying prescription opioids can lead to reservoirs of unused medication, creating opportunities for non-medical use and overdose. Pharmacy interventions have shown significant improvement in safe opioid prescribing practices at hospital discharge. However, inpatient discharges still represent a major source of high-volume opioid prescriptions. The purpose of this study is to evaluate hospital discharge opioid prescriptions and to assess the impact of data sharing and education on subsequent discharge prescribing practices. Methods: This was a retrospective review of discharge opioid prescriptions for adult hospitalist patients discharged from two, large, tertiary hospitals during July 2018, September 2019, and either February 2020 or February 18th thru March 18th, 2020 depending on the location. Eligible patients’ data elements including discharge opioid, quantity of opioid tablets (QTY), morphine milligram equivalence (MME), concomitant benzodiazepine prescription, ordering provider, and ordering department were evaluated for pre and post intervention implementation analysis. Data was collected through a review of orders in the electronic health record (EHR). Further investigation into charts was completed for necessary additional information if needed. The primary outcome is hospitalist group opioid discharge prescribing practices pre and post multiple interventions (EHR changes to default quantity on new orders, addition of MME daily calculation and provider education) and provider education alone presented on either January 21st or February 11th, 2020. Secondary outcomes include department and individual provider prescribing practices. This study has been approved by the institutional review board. Results: At Hospital A, both the average quantity of tablets and MME per discharge decreased post EHR and education interventions, then increased (25.8 to 23 to 25 and 198.3 to 177.5 to 195.6 respectively) post education only intervention. At Hospital B, a similar trend in both the average quantity of tablets and MME per discharge post interventions (34.9 to 23.3 to 25.8 and 303.5 to 191 to 212 respectively) was seen. The percentage of(62% to 62.7% to 67.5% at Hospital A and 50.6% to 70.2% to 66.5% at Hospital B). Conclusion: Results comparison prior to intervention (2018) to post intervention (2019 and 2020) indicate that it was effective in promoting safer prescribing practices however education/data sharing only intervention may be more effective when combined with more system orientated interventions. While longer term monitoring and individual provider follow up is needed to elicit the true impact of provider education and data sharing intervention, future efforts should combine multiple interventions. These should target the individual via continued education/data sharing and system processes via workflow adjustments such as encouraging utilizing new opioid orders upon discharge. Targeting specific service lines could help identify more opportunities to promote safer prescribing practices going forward.https://digitalcommons.psjhealth.org/pharmacy_PGY1/1001/thumbnail.jp