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Standard of practice that encourages oral and subcutaneous opioids leads to decreased IV opioids
Clinical Question
Can an intervention that promotes oral and subcutaneous opioid administration reduce the use of intravenous opioids in the hospital?
Bottom line
In this small, single-center study, a new opioid standard of practice that emphasized the use of oral and subcutaneous opioids, along with education of prescribers and nursing staff regarding this practice, reduced intravenous opioid use and decreased overall opioid exposure on a general medicine inpatient unit. These changes did not affect overall pain control. 2c
Reference
Study design: Other
Funding: Self-funded or unfunded
Setting: Inpatient (ward only)
Synopsis
These investigators studied the effect of an intervention aimed at reducing intravenous opioid use on a 28-bed general medicine inpatient unit at an academic medical center. The intervention consisted of the adoption of a local opioid standard of practice that preferred oral opioids when patients were able to tolerate oral intake and subcutaneous opioids when parenteral opioids were required. Additionally, prescribers and nursing staff received education via didactic presentations, email, and daily huddles to increase awareness of the new opioid standard of practice. Although intravenous opioid prescribing was not restricted, nurses were encouraged to remind prescribers of the new standard of practice. A 3-month intervention period was compared with a 6-month historical control period. Opioid use, overall, decreased by 23% during the intervention period (0.73 vs 0.95 doses per patient-day; P = .02). Specifically, parenteral opioid use (either intravenous or subcutaneous) decreased by 55% (0.18 vs 0.39 doses per patient-day; P < .001) and intravenous opioid use decreased by 84% (0.06 vs 0.39 doses per patient-day; P < .001). Of the total parenteral opioid administration during the intervention period, 65% was via the subcutaneous route as compared with less than 1% during the control period. Overall exposure to all opioids, as measured by morphine-milligram equivalents (MMEs), was reduced by 31% (6.30 vs 9.11 MMEs per patient-day). Compared with control patients, pain scores stayed similar for intervention patients during the first 3 hospital days and improved at day 4.
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL
Comments
Based on only population.what was of participation in dose and route of administration?
It is hard to understand why these results would occur.
Need larger prospective RCT trials on specific pain models...
I am retired from surgery for 7 yrs now as neurosurgeon we have morphine and other inject able narcotic but switched to oral or even feeding as soon we could , so I didn't understand what was of purpose study and what kind of patients group was used in this study Narcotic crises happening in the street why we looking to hospital or medical profession to correct that,
may be 2-3% related to inappropriate prescription , I quite agree with guide line but I find it less restrictive than the teaching I had from medical school.
Also I have to mention that majority chronic pain patient I see in my office they avoiding any kind pain medication from acetaminophen to morphine and few ask about CBD.
Authority should stop accusing patients and medical profession for Narcotic crises we should studies in street and social causes of homelessness and addiction and also source of narcotics in the street perhaps if social problem could be solved there will be no need and street Narcotic will stop.
Why would I promote opioids?
Good poem
Good topic but relevant to me