Risk and Benefit of Warfarin for Primary Prevention in Atrial Fibrillation Patients on Hemodialysis: A Retrospective Pilot Study
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Date
2020-07-17
Authors
Panic, Gea
McNorton, Kelly
Yrigoyen-Dacruz, Lidia
Duronio, Antoinette
Journal Title
Journal ISSN
Volume Title
Publisher
University of Waterloo
Abstract
Background
Despite increased awareness and advocacy regarding the opioid epidemic, data
from Health Quality Ontario (HQO) shows steady prescribing of opioids with
concerning trends toward prescribing more potent opioids. The creation of a
quality standard for Opioid Prescribing in Acute Pain provides opportunity
for organizations to assess whether they are meeting best practice
recommendations.
Objective
To examine opioid prescribing patterns for patients presenting to the
emergency department (ED) and to assess opioid prescribing at discharge in
comparison to HQO quality standards.
Methods
This retrospective, observational study examined adults presenting to two ED
sites within in a multi-site community teaching hospital. Patients prescribed
intravenous (IV)/intramuscular (IM)/subcutaneous (SC) morphine,
hydromorphone, and fentanyl were included. Patients were excluded if
intubated, palliative or end-of-life, being treated for overdose,
multi-fracture trauma, or admitted for inpatient treatment.
Results
Opioids were administered to 200 patients, with 12 patients receiving two
different opioids (n=212). The most common opioid was morphine (79.7%), route
was intravenous (92.9%), and frequency was as a one-time dose (46.2%). Common
indications included abdominal pain (32%), trauma (11%), and renal/biliary
colic (10.5%). A median parenteral morphine equivalent (MEQ) of 5 mg (IQR,
4-6.67 mg) was given, with 33.5% of patients receiving concurrent non-opioid
pain management. Patients who received hydromorphone (OR 6.37), were
prescribed as needed (OR 2.32), scheduled (OR 30.81) or repeated doses (OR
3.95), and had an indication of migraine or headache (OR 8.92) were more
likely to receive higher doses. At discharge, one in four patients received
an opioid prescription, most commonly for acetaminophen/oxycodone 325/5 mg
(46%) or acetaminophen/caffeine/codeine 300/15/30 mg (36%) with a median
duration of 3.1 days.
Conclusion
In summary, our organization showed reassuring prescribing patterns, meeting
HQO quality standards for dose and duration of discharge prescription.
Description
Keywords
opioid, acute pain, hydromorphone, morphine