Nudges (e.g., default order sets) in the electronic health record (EHR) have been shown to encourage safer prescribing of opioids in emergency departments. This study evaluated the effect of nudges to reduce opioid prescribing for opioid-naïve patients with acute pain. Primary care practices were cluster randomized to control, opioid justification in the EHR, peer comparison, or combined opioid justification and peer comparison groups. The three intervention groups showed reduced opioid prescribing compared to control.

One element of conservative prescribing is minimizing the number of medications prescribed. This study compared the number of unique, newly prescribed medications (personal formularies) of primary care physicians across four health systems. Results indicated wide variability in the number of unique medications at the physician and institution levels. Further exploration of personal formularies and core drugs may illuminate opportunities for safer and more appropriate prescribing.

This study analyzed the association between potentially inappropriate prescribing involving opioids prescribed by dentists and emergency department visits and hospitalizations among older patients. Results indicated that a significant proportion of older patients prescribed opioids by their dentist have contraindications (such as psychotropic medication use) which places them at increased risk for 30-day hospitalizations.

National guidelines published in 2016 recommend prescribing low-dose opioids for short durations when necessary, including in dentistry practices. This cross-sectional analysis of over 500,000 commercial dental patients over a five-year period (2011-2015) examined prescribing practices prior to the recommendations and found that 29% of prescribed opioids exceeded the recommended dose for management of acute pain and half (53%) exceeded the recommended days’ supply. The authors emphasize the importance of evidence-based interventions tailored to dentistry to curtail excessive opioid prescribing.

This article reports mixed results of a two-year mentor-implemented feasibility study designed to improve medication reconciliation practices in rural Veterans Affairs hospitals. The authors highlight facilitators and barriers to implementing their evidence-based intervention in smaller hospitals.

… quality improvement study, five hospitals implemented a standardized approach to admission and discharge medication … The toolkit was implemented at each study site by a pharmacist and a hospitalist with support from local leadership. The …

… Journal of general internal medicine … J Gen Intern Med … State-based prescription drug monitoring … to enhance existing efforts to curb the opioid epidemic . A WebM&M commentary highlighted the utility of prescription …

Opioid medications are a known safety hazard, and overdoses of opioid medications are considered an epidemic in the United States. This commentary discusses US Veterans Affairs health system initiatives that focus on education, prescription monitoring, pain management, risk mitigation, and use of guidelines to reduce risks associated with opioids.

Prior research suggests that polypharmacy in patients with dementia may increase the risk of functional decline. This retrospective cohort study found that veterans with dementia who sought care from both within the Department of Veterans Affairs (VA) and from other health systems were more likely to receive prescriptions for potentially unsafe medications than those who sought care only within the VA system.

This health system performance study ranked sites within the Veterans Affairs health system using two measures of potentially inappropriate prescribing in older veterans. Researchers found that sites ranked similarly when they used new potentially inappropriate medications to measure performance compared to when they used existing potentially inappropriate medications as the measure. These results suggest that measuring new potentially inappropriate prescriptions is a feasible strategy worthy of further study.

… of the American Medical Informatics Association : JAMIA … J Am Med Inform Assoc … More than half of older adults …

This commentary describes a medication reconciliation improvement toolkit, along with results and lessons learned from implementing the strategy.

Although pharmacists have been shown to be effective at preventing medication errors in the inpatient setting, this prospective study found that inpatient physicians accepted less than half of their recommendations.

… Journal of the American Geriatrics Society … J Am Geriatr Soc … Substantial variation was found between …

… of the American Society of Health-System Pharmacists … Am J Health Syst Pharm … This article discusses using automated …

This study implemented new physician handoff software that improved consistency of information transfer and perception of patient handoff within a Veterans Affairs health care system.

… Journal of general internal medicine … J Gen Intern Med … This study demonstrates opportunities for … teams and primary care providers but does not find a relationship between these communications and patient …

This systematic review evaluated 36 studies that encompassed pharmacy participation in patient rounds and medication reconciliation efforts as well as drug-specific pharmacist services. The authors detail the individual and collective findings, which include reductions in adverse drug events or errors in more than half the trials with improvements in medication adherence, knowledge, and appropriateness in a similar proportion. None of the studies demonstrated a worse overall outcome, and only one suggested increased health care utilization. The authors outline the needs for future investigation around roles for clinical pharmacists, clinical areas and patients most likely to benefit from their services, and better models to determine cost effectiveness.