Reducing inappropriate supply of opioids at hospital discharge

A. V. Gilbert, M. Morrow, J. H. Crofton, T. L. N. Pogue, B. K. Patel

Research output: Contribution to conferenceAbstractResearch

Abstract

Background: Opioids are an area of global concern from a public health perspective. Between 2008 and 2014, there was an 87% increase in prescription opioid related deaths in Australia, with the greatest increase occurring in rural/regional Australia which saw a 148% increase. It is thought that inappropriate opioids prescribed at discharge from hospital are contributing to this epidemic. This study was conducted in an Australian tertiary hospital which utilises an electronic medicines management system (EMMS). To comply with regulatory requirements, Australian prescribers are required to write the quantity of opioids in words and figures on the prescription. A decision support alert (DSA) is provided on EMMS to remind prescribers of this requirement when they prescribe oxycodone IR on discharge.

Objectives: To determine if decreasing the example quantity within the DSA reduces the quantity of oxycodone IR prescribed at discharge.

Methods: A retrospective audit of prescriptions and dispensing data was used to analyse pre and post intervention data. During period 1 (01‐15/06/2017), the DSA stated “please supply twenty (20) tablets” when prescribing oxycodone IR on discharge. The DSA was changed on the 28/08/2017 to “please supply ten (10) tablets.” Post intervention data was examined in period 2 (01‐15/11/2017). Proportion of discharges containing oxycodone IR, quantity provided and appropriateness of quantity supply was compared between the two time periods. Appropriateness was assessed by opioid use 48 h prior to discharge converted to a 3‐day quantity of oxycodone IR by using a conversion table within Therapeutic Guidelines. Doses were rounded up to whole tablets; supply quantity was deemed appropriate if the supply was equal or less than the individually calculated 3‐day requirement.

Results: 587 discharges were dispensed in period 1; 147 (25%) contained an opioid, with the most common being oxycodone IR, 130 (22%), In period 2, 633 discharges were dispensed with 176 containing an opioid (28%), 137 being oxycodone IR (22%). There was no significant change in the quantity of oxycodone IR provided in the two periods, 1584 vs 1552 (p = 0.57); the appropriateness of the quantity supplied (appropriate quantities for 43 patients vs 48, p = 0.74); patients who were provided oxycodone IR on discharge after not receiving a dose of opioids 48 h prior to discharge, 32 vs 26 (p = 0.26).

Conclusions: A change to the DSA provided at the time of prescribing on discharge did not decrease the quantity or appropriateness of oxycodone IR supplied.
Original languageEnglish
Pages501-501
Number of pages1
DOIs
Publication statusPublished - 17 Aug 2018
Event34th International Conference on Pharmacoepidemiology & Therapeutic Risk Management - Prague Congress Centre, Prague, Czech Republic
Duration: 22 Aug 201826 Aug 2018

Conference

Conference34th International Conference on Pharmacoepidemiology & Therapeutic Risk Management
CountryCzech Republic
CityPrague
Period22/08/1826/08/18

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Oxycodone
Opioid Analgesics
Tablets
Prescriptions
Systems Analysis
Tertiary Care Centers
Public Health
Guidelines

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Gilbert, A. V., Morrow, M., Crofton, J. H., Pogue, T. L. N., & Patel, B. K. (2018). Reducing inappropriate supply of opioids at hospital discharge. 501-501. Abstract from 34th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Prague, Czech Republic. https://doi.org/10.1002/pds.4629
Gilbert, A. V. ; Morrow, M. ; Crofton, J. H. ; Pogue, T. L. N. ; Patel, B. K. / Reducing inappropriate supply of opioids at hospital discharge. Abstract from 34th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Prague, Czech Republic.1 p.
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abstract = "Background: Opioids are an area of global concern from a public health perspective. Between 2008 and 2014, there was an 87{\%} increase in prescription opioid related deaths in Australia, with the greatest increase occurring in rural/regional Australia which saw a 148{\%} increase. It is thought that inappropriate opioids prescribed at discharge from hospital are contributing to this epidemic. This study was conducted in an Australian tertiary hospital which utilises an electronic medicines management system (EMMS). To comply with regulatory requirements, Australian prescribers are required to write the quantity of opioids in words and figures on the prescription. A decision support alert (DSA) is provided on EMMS to remind prescribers of this requirement when they prescribe oxycodone IR on discharge.Objectives: To determine if decreasing the example quantity within the DSA reduces the quantity of oxycodone IR prescribed at discharge.Methods: A retrospective audit of prescriptions and dispensing data was used to analyse pre and post intervention data. During period 1 (01‐15/06/2017), the DSA stated “please supply twenty (20) tablets” when prescribing oxycodone IR on discharge. The DSA was changed on the 28/08/2017 to “please supply ten (10) tablets.” Post intervention data was examined in period 2 (01‐15/11/2017). Proportion of discharges containing oxycodone IR, quantity provided and appropriateness of quantity supply was compared between the two time periods. Appropriateness was assessed by opioid use 48 h prior to discharge converted to a 3‐day quantity of oxycodone IR by using a conversion table within Therapeutic Guidelines. Doses were rounded up to whole tablets; supply quantity was deemed appropriate if the supply was equal or less than the individually calculated 3‐day requirement.Results: 587 discharges were dispensed in period 1; 147 (25{\%}) contained an opioid, with the most common being oxycodone IR, 130 (22{\%}), In period 2, 633 discharges were dispensed with 176 containing an opioid (28{\%}), 137 being oxycodone IR (22{\%}). There was no significant change in the quantity of oxycodone IR provided in the two periods, 1584 vs 1552 (p = 0.57); the appropriateness of the quantity supplied (appropriate quantities for 43 patients vs 48, p = 0.74); patients who were provided oxycodone IR on discharge after not receiving a dose of opioids 48 h prior to discharge, 32 vs 26 (p = 0.26).Conclusions: A change to the DSA provided at the time of prescribing on discharge did not decrease the quantity or appropriateness of oxycodone IR supplied.",
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Gilbert, AV, Morrow, M, Crofton, JH, Pogue, TLN & Patel, BK 2018, 'Reducing inappropriate supply of opioids at hospital discharge' 34th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Prague, Czech Republic, 22/08/18 - 26/08/18, pp. 501-501. https://doi.org/10.1002/pds.4629

Reducing inappropriate supply of opioids at hospital discharge. / Gilbert, A. V.; Morrow, M.; Crofton, J. H.; Pogue, T. L. N.; Patel, B. K.

2018. 501-501 Abstract from 34th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Prague, Czech Republic.

Research output: Contribution to conferenceAbstractResearch

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T1 - Reducing inappropriate supply of opioids at hospital discharge

AU - Gilbert, A. V.

AU - Morrow, M.

AU - Crofton, J. H.

AU - Pogue, T. L. N.

AU - Patel, B. K.

PY - 2018/8/17

Y1 - 2018/8/17

N2 - Background: Opioids are an area of global concern from a public health perspective. Between 2008 and 2014, there was an 87% increase in prescription opioid related deaths in Australia, with the greatest increase occurring in rural/regional Australia which saw a 148% increase. It is thought that inappropriate opioids prescribed at discharge from hospital are contributing to this epidemic. This study was conducted in an Australian tertiary hospital which utilises an electronic medicines management system (EMMS). To comply with regulatory requirements, Australian prescribers are required to write the quantity of opioids in words and figures on the prescription. A decision support alert (DSA) is provided on EMMS to remind prescribers of this requirement when they prescribe oxycodone IR on discharge.Objectives: To determine if decreasing the example quantity within the DSA reduces the quantity of oxycodone IR prescribed at discharge.Methods: A retrospective audit of prescriptions and dispensing data was used to analyse pre and post intervention data. During period 1 (01‐15/06/2017), the DSA stated “please supply twenty (20) tablets” when prescribing oxycodone IR on discharge. The DSA was changed on the 28/08/2017 to “please supply ten (10) tablets.” Post intervention data was examined in period 2 (01‐15/11/2017). Proportion of discharges containing oxycodone IR, quantity provided and appropriateness of quantity supply was compared between the two time periods. Appropriateness was assessed by opioid use 48 h prior to discharge converted to a 3‐day quantity of oxycodone IR by using a conversion table within Therapeutic Guidelines. Doses were rounded up to whole tablets; supply quantity was deemed appropriate if the supply was equal or less than the individually calculated 3‐day requirement.Results: 587 discharges were dispensed in period 1; 147 (25%) contained an opioid, with the most common being oxycodone IR, 130 (22%), In period 2, 633 discharges were dispensed with 176 containing an opioid (28%), 137 being oxycodone IR (22%). There was no significant change in the quantity of oxycodone IR provided in the two periods, 1584 vs 1552 (p = 0.57); the appropriateness of the quantity supplied (appropriate quantities for 43 patients vs 48, p = 0.74); patients who were provided oxycodone IR on discharge after not receiving a dose of opioids 48 h prior to discharge, 32 vs 26 (p = 0.26).Conclusions: A change to the DSA provided at the time of prescribing on discharge did not decrease the quantity or appropriateness of oxycodone IR supplied.

AB - Background: Opioids are an area of global concern from a public health perspective. Between 2008 and 2014, there was an 87% increase in prescription opioid related deaths in Australia, with the greatest increase occurring in rural/regional Australia which saw a 148% increase. It is thought that inappropriate opioids prescribed at discharge from hospital are contributing to this epidemic. This study was conducted in an Australian tertiary hospital which utilises an electronic medicines management system (EMMS). To comply with regulatory requirements, Australian prescribers are required to write the quantity of opioids in words and figures on the prescription. A decision support alert (DSA) is provided on EMMS to remind prescribers of this requirement when they prescribe oxycodone IR on discharge.Objectives: To determine if decreasing the example quantity within the DSA reduces the quantity of oxycodone IR prescribed at discharge.Methods: A retrospective audit of prescriptions and dispensing data was used to analyse pre and post intervention data. During period 1 (01‐15/06/2017), the DSA stated “please supply twenty (20) tablets” when prescribing oxycodone IR on discharge. The DSA was changed on the 28/08/2017 to “please supply ten (10) tablets.” Post intervention data was examined in period 2 (01‐15/11/2017). Proportion of discharges containing oxycodone IR, quantity provided and appropriateness of quantity supply was compared between the two time periods. Appropriateness was assessed by opioid use 48 h prior to discharge converted to a 3‐day quantity of oxycodone IR by using a conversion table within Therapeutic Guidelines. Doses were rounded up to whole tablets; supply quantity was deemed appropriate if the supply was equal or less than the individually calculated 3‐day requirement.Results: 587 discharges were dispensed in period 1; 147 (25%) contained an opioid, with the most common being oxycodone IR, 130 (22%), In period 2, 633 discharges were dispensed with 176 containing an opioid (28%), 137 being oxycodone IR (22%). There was no significant change in the quantity of oxycodone IR provided in the two periods, 1584 vs 1552 (p = 0.57); the appropriateness of the quantity supplied (appropriate quantities for 43 patients vs 48, p = 0.74); patients who were provided oxycodone IR on discharge after not receiving a dose of opioids 48 h prior to discharge, 32 vs 26 (p = 0.26).Conclusions: A change to the DSA provided at the time of prescribing on discharge did not decrease the quantity or appropriateness of oxycodone IR supplied.

KW - Public, Environmental & Occupational Health Pharmacology & Pharmacy

U2 - 10.1002/pds.4629

DO - 10.1002/pds.4629

M3 - Abstract

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Gilbert AV, Morrow M, Crofton JH, Pogue TLN, Patel BK. Reducing inappropriate supply of opioids at hospital discharge. 2018. Abstract from 34th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Prague, Czech Republic. https://doi.org/10.1002/pds.4629