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Modifying emergency department electronic prescribing for outpatient opioid analgesia.
Emerg Med Australas. 2019 06; 31(3):417-422.EM

Abstract

OBJECTIVES

The aim of this study was to examine how changing the electronic ordering sequences for opioid analgesics affected ED outpatient prescribing, and subsequent unused opioid tablets remaining in the community available for diversion.

METHODS

A descriptive before and after study in adult patients prescribed an opioid analgesic by an ED prescriber for use in the outpatient setting. The hospital electronic prescribing system (FirstNet™) was modified to include smaller quantities of opioid analgesics for discharge. The change in quantity of opioid prescribed and change in quantity of opioid analgesic remaining in the community at follow up was measured pre- and post-intervention using a structured telephone interview.

RESULTS

Pre- and post-intervention, 102 and 106 patients were interviewed, respectively. Percentage of prescriptions for oxycodone quantity five tablets increased from 3% to 32% and for quantity 20 tablets fell from 40% to 24% post-intervention. For paracetamol with codeine, prescriptions for quantity 10 tablets increased from 2% to 24% while for quantity 20 tablets fell from 98% to 76%. Mean number of tablets prescribed per patient fell from 13.8 (SD = 5.1) to 10.8 (SD = 5.6) for oxycodone and from 19.8 (SD = 1.5) to 17.6 (SD = 4.2) for paracetamol with codeine. Fifty-eight percent of patients in both pre- and post-intervention groups used half or less of the medication prescribed.

CONCLUSION

Modification of an ED electronic prescribing system reduced overall quantities of opioid analgesics supplied and subsequently stored in the community but did not change the proportion of patients (>50%) who reported using half or less of their prescribed opioid medication.

Authors+Show Affiliations

Emergency Medicine, Austin Health, Melbourne, Victoria, Australia.Emergency Medicine, Austin Health, Melbourne, Victoria, Australia. Pharmacy Department, Austin Health, Melbourne, Victoria, Australia.Emergency Medicine, Austin Health, Melbourne, Victoria, Australia.Emergency Medicine, Austin Health, Melbourne, Victoria, Australia. Clinical Toxicology Service, Austin Hospital, Melbourne, Victoria, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30508874

Citation

Schwartz, Grace D., et al. "Modifying Emergency Department Electronic Prescribing for Outpatient Opioid Analgesia." Emergency Medicine Australasia : EMA, vol. 31, no. 3, 2019, pp. 417-422.
Schwartz GD, Harding AM, Donaldson SR, et al. Modifying emergency department electronic prescribing for outpatient opioid analgesia. Emerg Med Australas. 2019;31(3):417-422.
Schwartz, G. D., Harding, A. M., Donaldson, S. R., & Greene, S. L. (2019). Modifying emergency department electronic prescribing for outpatient opioid analgesia. Emergency Medicine Australasia : EMA, 31(3), 417-422. https://doi.org/10.1111/1742-6723.13192
Schwartz GD, et al. Modifying Emergency Department Electronic Prescribing for Outpatient Opioid Analgesia. Emerg Med Australas. 2019;31(3):417-422. PubMed PMID: 30508874.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modifying emergency department electronic prescribing for outpatient opioid analgesia. AU - Schwartz,Grace D, AU - Harding,Andrew M, AU - Donaldson,Síne R, AU - Greene,Shaun L, Y1 - 2018/12/03/ PY - 2018/06/25/received PY - 2018/09/23/revised PY - 2018/09/25/accepted PY - 2018/12/7/pubmed PY - 2020/5/27/medline PY - 2018/12/4/entrez KW - analgesics KW - electronic prescribing KW - emergency medicine KW - opioid KW - oxycodone SP - 417 EP - 422 JF - Emergency medicine Australasia : EMA JO - Emerg Med Australas VL - 31 IS - 3 N2 - OBJECTIVES: The aim of this study was to examine how changing the electronic ordering sequences for opioid analgesics affected ED outpatient prescribing, and subsequent unused opioid tablets remaining in the community available for diversion. METHODS: A descriptive before and after study in adult patients prescribed an opioid analgesic by an ED prescriber for use in the outpatient setting. The hospital electronic prescribing system (FirstNet™) was modified to include smaller quantities of opioid analgesics for discharge. The change in quantity of opioid prescribed and change in quantity of opioid analgesic remaining in the community at follow up was measured pre- and post-intervention using a structured telephone interview. RESULTS: Pre- and post-intervention, 102 and 106 patients were interviewed, respectively. Percentage of prescriptions for oxycodone quantity five tablets increased from 3% to 32% and for quantity 20 tablets fell from 40% to 24% post-intervention. For paracetamol with codeine, prescriptions for quantity 10 tablets increased from 2% to 24% while for quantity 20 tablets fell from 98% to 76%. Mean number of tablets prescribed per patient fell from 13.8 (SD = 5.1) to 10.8 (SD = 5.6) for oxycodone and from 19.8 (SD = 1.5) to 17.6 (SD = 4.2) for paracetamol with codeine. Fifty-eight percent of patients in both pre- and post-intervention groups used half or less of the medication prescribed. CONCLUSION: Modification of an ED electronic prescribing system reduced overall quantities of opioid analgesics supplied and subsequently stored in the community but did not change the proportion of patients (>50%) who reported using half or less of their prescribed opioid medication. SN - 1742-6723 UR - https://www.unboundmedicine.com/medline/citation/30508874/Modifying_emergency_department_electronic_prescribing_for_outpatient_opioid_analgesia_ L2 - https://doi.org/10.1111/1742-6723.13192 DB - PRIME DP - Unbound Medicine ER -