Risk and Benefit of Warfarin for Primary Prevention in Atrial Fibrillation Patients on Hemodialysis: A Retrospective Pilot Study

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.