Preventing Iatrogenic Overdose: A Review of In–Emergency Department Opioid-Related Adverse Drug Events and Medication Errors

Beaudoin, Francesca L.; Merchant, Roland C.; Janicki, Adam; McKaig, Donald; Babu, Kavita M.

doi:10.1016/j.annemergmed.2014.11.016

Cited by 30 publications

(30 citation statements)

References 20 publications

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“…However, evidence suggests that the emphasis on reducing pain and under‐representation of opioid‐related harms have contributed to the present overuse of opioid analgesics, particularly in the management of both acute and chronic noncancer pain . Moreover, growing evidence of opioid‐related harms, including increased morbidity and mortality, puts into question the safety of extensive opioid use . Very few interventions specifically assessed the therapeutic benefit of ongoing analgesic treatment or monitored for cases in which harms related to opioid use outweighed the benefits.…”

Section: Discussionmentioning

confidence: 99%

“…58,59 Moreover, growing evidence of opioid-related harms, including increased morbidity and mortality, puts into question the safety of extensive opioid use. [60][61][62] Very few interventions specifically assessed the therapeutic benefit of ongoing analgesic treatment or monitored for cases in which harms related to opioid use outweighed the benefits. Therefore, the implementation of policies to reinforce the equal weighting of opioidrelated risks and benefits are warranted to facilitate a balanced approach to pain management.…”

Section: Policy and Research Implicationsmentioning

confidence: 99%

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Effectiveness of interventions on the appropriate use of opioids for noncancer pain among hospital inpatients: A systematic review

Liu

Gnjidic

Nguyen

et al. 2020

Brit J Clinical Pharma

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Aims To summarise the effectiveness of interventions on appropriate opioid use for noncancer pain among hospital inpatients. Methods Two reviewers independently searched 6 databases up to March 2018 original research articles reporting on quantitative outcomes of interventions on appropriate opioid use among hospital inpatients. Appropriate opioid use was measured by changes in prescribing, such as the lowest effective opioid dose and duration, or clinical outcomes such as adequate pain control. Quality and intervention complexity assessments were performed by 2 independent reviewers. The full methodological approach was published on PROSPERO (ID: CRD42019145947). Results Of 398 full‐text articles assessed for eligibility, 37 articles were included in the review. Most articles had a moderate or high risk of bias (27 of 37 studies). Thirty‐one articles primarily addressed appropriate opioid use and 6 articles targeted opioid safety as a secondary outcome. A multifaceted approach was the most common primary intervention (16 studies) and adequate pain control was the main outcome measured (14 studies). Health provider education, reinforced by hard‐copy material and feedback, was associated with a 13.0 to 29.5% increase in the proportion of opioid prescriptions written in concordance with local guidelines and reduced pain scores ranging from 7.0 to 34.5%. Interventions to improve opioid safety in patient‐controlled analgesia reduced medication errors by up to 89.1%. Conclusion Interventions involving academic detailing and education, especially when reinforced by feedback, show positive effects on appropriate opioid use among hospital inpatients. Future studies investigating the impact of administrative interventions on opioid use and related outcomes are warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Policy and Research Implicationsmentioning

confidence: 99%

Effectiveness of interventions on the appropriate use of opioids for noncancer pain among hospital inpatients: A systematic review

Liu

Gnjidic

Nguyen

et al. 2020

Brit J Clinical Pharma

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“…7 Coupled with these increases in prescription use and misuse, iatrogenic injury due to opioid analgesic administration in the ED has recently been examined. In 2015, Beaudoin et al 8 identified 73 ED patients in 2 urban academic EDs in which naloxone administration was required because of iatrogenic overdose after opioid administration. Patient-, provider-, and systems-based risk factors included chronic medical conditions; failure to adjust dosing in the elderly, and renal and hepatic impairment; multiple doses and routes of administration; coadministration of sedatives; problems with patient hand-offs; consideration of patient sex; and pharmacy error.…”

Section: Introductionmentioning

confidence: 99%

Perception and Practice Among Emergency Medicine Health Care Providers Regarding Discharging Patients After Opioid Administration

Surmaitis

Amaducci

Henry

et al. 2018

Clinical Therapeutics

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Most study participants believed that developing a policy or guideline for safe discharge after administration opioids in the ED is important to clinical practice. Only a few physicians reported that they did not prescribe intramuscular hydromorphone or morphine. Most participants believed the discharge decision after administration of opioids in the ED should be primarily determined by both the emergency medicine provider and the RN.

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“…Incorporate a discussion on the studies revealing an increased risk of long-term opioid use after administration in the acute setting [4][5][6]. Educators can also provide literature introducing the concept of Biatrogenic addiction^ [7][8][9][10][11]. Education: remind the trainee that part of treating pain properly involves patient education, including explaining to patients why particular medications are selected for them, the risks and side effects of the medication, and resources available to patients who become dependent on a prescribed medication [12].…”

mentioning

confidence: 99%

“…As the opioid epidemic continues to gain attention in the medical world and mainstream press, medical educators are moving to standardize the education of providers in appropriate pain management, safer prescribing patterns, and the use of prescription monitoring databases [7][8][9][10][13][14][15][16][17]. The toxicology rotation holds great potential as a transformative experience for the medical trainee on this topic, and toxicologists are uniquely poised to seamlessly integrate this training into daily didactics and case discussions.…”

mentioning

confidence: 99%

The Toxicologist as Educator: Addressing Pain Management in the Midst of an Opioid Epidemic

Beauchamp

2015

J. Med. Toxicol.

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We call it the Bmonthly rant^at the Oregon and Alaska Poison Center: a rotating student or resident presents a case of an opioid poisoning and a well-prepared overview of the toxicokinetics and toxicodynamics of opioids in overdose. The eyes of the fellows and attendings meet briefly, and the moment is perfect for an in-depth discussion about the complexities of opioid prescribing, pain management, and pitfalls of opioid therapy. What ensues is a carefully designed discussion surrounding several key components of appropriate pain management and iatrogenic addiction. With an increasing focus on the opioid epidemic and prevention of addiction, medical educators are actively working to design pain management curricula. It is worth highlighting that many toxicologists already incorporate this education for rotators on the toxicology service and that toxicologists are a valuable resource for medical educators involved in the re-designing of medical curricula.The toxicology rotation seems an ideal place to formally educate trainees to manage pain while attenuating diversion, adverse effects, polypharmacy, and iatrogenic addiction. Whether students and residents spend a day, a week, or a month on the toxicology service, educators can use this opportunity to introduce new approaches toward opioid use in pain management, thus laying the groundwork to reduce morbidity and mortality from opioids. Participants in the discussions on our service typically include third or fourth year medical students, pharmacy students, and emergency medicine residents on their toxicology rotation, who will go on to treat patients with acute and chronic painful conditions in all fields of medicine. Even early in training, students and residents make astute observations about the challenges and pitfalls surrounding the management of acute and chronic pain.Promoting awareness and introducing a primer for good prescribing habits early in training may have a significant impact on the future practices of rotators. One way to do this is to review four key aspects for providing care to the patient with an acute or chronically painful condition. The simplest approach is to integrate this review during toxicology rounds where trainees already participate in opioid exposure and overdose case discussions.

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Preventing Iatrogenic Overdose: A Review of In–Emergency Department Opioid-Related Adverse Drug Events and Medication Errors

Cited by 30 publications

References 20 publications

Effectiveness of interventions on the appropriate use of opioids for noncancer pain among hospital inpatients: A systematic review

Effectiveness of interventions on the appropriate use of opioids for noncancer pain among hospital inpatients: A systematic review

Perception and Practice Among Emergency Medicine Health Care Providers Regarding Discharging Patients After Opioid Administration

The Toxicologist as Educator: Addressing Pain Management in the Midst of an Opioid Epidemic

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