Continuation of Opioid Therapy at Transitions of Care in Critically Ill Patients

Witcraft, Emily; Gonzales, Jeffrey; Seung, Hyunuk; Watt, Ian; Tata, Asha; Yeung, Siu Yan Amy; Heavner, Mojdeh; Qato, Dima M.; Gulati, Mangla; Millstein, Leah

doi:10.1177/0885066620933798

Cited by 12 publications

(16 citation statements)

References 19 publications

(26 reference statements)

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“…Similarly, in another retrospective cohort study, cumulative opioid dose was noted to be a potentially important differentiating factor between those who received an opioid at discharge compared with those that did not. 13 Contrary to these findings, our cohort of opioid-naïve patients admitted to the ICU did not demonstrate similar relationships. This could be explained by our increased ability to control for potentially confounding variables, which was a component lacking from previous analyses.…”

Section: Discussioncontrasting

confidence: 85%

“…In addition to cumulative hospital opioid exposure, hospital LOS may be a predictor of discharge opioid receipt, consistent with our findings that patients with a discharge opioid prescription had a longer hospital LOS. 13 We evaluated ICU MME exposure, rather than total hospital exposure, based on the primary intent of our study. Non-ICU LOS, rather than total LOS, was utilized because there was an observed difference in the compared groups between total hospital LOS but not ICU LOS.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Opioid Administration in the Intensive Care Unit and Subsequent Use in Opioid-Naïve Patients

et al. 2021

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Background Opioids are a mainstay of therapy for patients in the intensive care unit (ICU) as part of the analgesia-first approach to sedation. Despite knowledge of acute consequences of opioid based analgosedation, less is known about the potential long-term consequences, including the effect of opioid administration in the ICU on subsequent opioid use in opioid-naïve patients. Objective To evaluate the relationship between ICU opioid administration to opioid-naïve patients and subsequent opioid use following discharge. Methods A query of the electronic medical record was performed to identify opioid-naïve adult patients admitted directly to an ICU. Patients who received continuous intravenous infusion of fentanyl, hydromorphone, or morphine were screened for inclusion into the analysis. Results Of the 342 patients included for analysis, 164 (47.1%) received an opioid at hospital discharge. In total, 17 of the 342 patients (5.0%) became long-term users, noted to be more common in patients who received an opioid prescription at discharge (8.7% vs 1.6%; P = 0.006). Neither total ICU morphine milligram equivalent (MME) nor average daily ICU MME administration were found to correlate with daily MME prescription quantity at discharge ( R2 = 0.008 and R2 = 0.03, respectively). Following control for potentially confounding variables, total ICU MME administration remained an insignificant predictor of subsequent receipt of an opioid prescription at discharge and long-term opioid use. Conclusion and Relevance This study failed to find a significant relationship between ICU opioid use in opioid-naïve patients and subsequent opioid use. These findings highlight the need to focus on transitions points between the ICU and discharge as potential opportunities to reduce inappropriate opioid continuation.

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Section: Discussioncontrasting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Impact of Opioid Administration in the Intensive Care Unit and Subsequent Use in Opioid-Naïve Patients

et al. 2021

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“…The model has a good clinical application effect [ 4 ]. Studies have found that the Omaha system has a good effect in patients with hypertension, lung diseases, and urostomy, but it is less used in patients undergoing radical prostatectomy [ 5 ]. Continuing care refers to the ability of patients to continue to receive professional medical care after leaving the original medical environment to promote health recovery [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Efficacy and Psychological Impact of Omaha-Based Continuing Care for Prostate Cancer Patients

Liu

Wang

Zhang

et al. 2022

Computational and Mathematical Methods in Medicine

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Prostate cancer is a common malignancy elderly male urogenital system, because of the special disease position, and postoperative complications such as urinary retention, urinary incontinence, and sexual dysfunction, if not treated, can increase the patients’ physical pain, anxiety, and other psychological burden; endocrine therapy after surgery can affect self-image and quality of life of patients. Omaha system was originally used for community health nurses, which contains three main contents: problem classification, nursing intervention, and outcome evaluation. The problem classification dimension includes four dimensions: environment, physiology, social psychology, and health-related behavior. The nursing intervention dimension is composed of 75 intervention objectives and four behavior types. Omaha system is a nursing intervention model based on individual psychological, physiological, educational level, and family and social background. The model has good clinical application effect. This study aimed to explore the continuous nursing intervention effect in the nursing of patients with prostate cancer and its psychological impact. A total of 96 prostate patients with cancer who were admitted to Taizhou First People’s Hospital from November 2019 to May 2021 were divided into Omaha system care group and routine care group with 48 cases each by random number table method. The routine care group received routine care and discharge guidance, and the Omaha system care group on the basis of the routine care group; continuation care based on the Omaha system was implemented. The differences in mental state, life quality score, serum prostate specific antigen (PSA) level, average urine flow rate, and self-care ability score were compared between the routine care and Omaha system care group. The results showed that Omaha-based continuation care for prostate cancer is beneficial to reduce bad mood, improve patients’ life quality score and self-care ability, and provide certain reference for clinical care of prostate cancer patients.

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“…Few studies evaluating persistent opioid use after critical illness reported ICU opioid doses (23)(24)(25); among opioid-naïve patients, Krancevich et al (23) and Witcraft et al (24) found no association between ICU opioid dose and persistent opioid use), and Tollinche et al (25) observed that patients who received opioids in the ICU were less likely to receive an opioid prescription at discharge. Witcraft et al (24) found that intubation and hospital (but not ICU) opioid dose were associated with continuing opioids at discharge. In our multivariable analyses, neither of these factors was associated with persistent opioid use for OPTA or non-OPTA patients.…”

Section: Discussionmentioning

confidence: 99%

Opioid Prescribing Patterns Before, During, and After Critical Illness: An Observational Study

Wampole

McKenna

Riker

et al. 2022

Critical Care Explorations

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The association between opioid therapy during critical illness and persistent opioid use after discharge is understudied relative to ICU opioid exposure and modifiable risk factors. Our objectives were to compare persistent opioid use after discharge among patients with and without chronic opioid use prior to admission (OPTA) and identify risk factors associated with persistent use. DESIGN:Retrospective cohort study. SETTING: Medical, trauma/surgical, or neurologic ICU at an academic hospital. PARTICIPANTS: Adult patients surviving hospital admission. INTERVENTIONS:Opioid use during the ICU and post-ICU stays. MEASUREMENTS AND MAIN RESULTS:The primary outcome was persistent opioid use accounting for greater than 70% of days 4-6 months after discharge. Among 2,975 included patients, 257 (8.6%) were classified as OPTA, and 305 (10.2%) persistently filled opioid prescriptions, including 186/257 (72%) OPTA and 119/2,718 (4.4%) with no chronic opioid fills prior to admission. Among all patients, OPTA was strongly associated with persistent opioid use (odds ratio, 57.2 [95% CI,). Multivariable logistic regression revealed that male sex, surgical procedure, and ICU opioid-free days were associated with reduced persistent opioid use for OPTA patients. Age and ICU opioid-free days were associated with reduced persistent opioid use for non-OPTA patients. Total ICU opioid dose and dose per day of ICU exposure were not associated with persistent use for either group. CONCLUSIONS:In this mixed cohort of ICU patients, 10.2% persistently filled opioid prescriptions 4-6 months after discharge. Although ICU opioid doses were not associated with persistent use, duration of ICU opioid administration is a modifiable risk factor that may reduce persistent opioid use after critical illness.

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Continuation of Opioid Therapy at Transitions of Care in Critically Ill Patients

Cited by 12 publications

References 19 publications

Impact of Opioid Administration in the Intensive Care Unit and Subsequent Use in Opioid-Naïve Patients

Impact of Opioid Administration in the Intensive Care Unit and Subsequent Use in Opioid-Naïve Patients

Clinical Efficacy and Psychological Impact of Omaha-Based Continuing Care for Prostate Cancer Patients

Opioid Prescribing Patterns Before, During, and After Critical Illness: An Observational Study

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