Best practices for treating patients with opioid use disorder (OUD) include prescribing medications to treat OUD (naltrexone, naloxone, or buprenorphine) and limiting prescriptions of high-risk medications (opioid analgesics and benzodiazepines). This study of more than 23,000 patients with an index event related to OUD sought to determine racial and ethnic differences in safe prescribing. White patients were significantly more likely to receive buprenorphine and less likely to receive high-risk medications than Black or Hispanic patients in the 180 days after the index event. This difference persisted over the four-year study period.

… alignment between clinicians and leaders . … Linzer M, Neprash H, Brown R, et al. Where trust flourishes: …

… to return with a similar illness within two weeks. … Neprash HT, Sheridan B, Jena AB, et al. Evidence of …

Adolescent patients transitioning from pediatric to adult medicine may experience patient safety risks. Using a large commercial insurance claims database, the authors compared opioid prescribing patterns and risk for opioid-related adverse events (overdose, opioid use disorder, or long-term use) among adolescents transitioning from “child” to “adult” at 18 years of age. The authors estimate a 14% increased risk for an opioid-related adverse outcome within one year when “adults” just over age 18 years were prescribed opioids that would not have been prescribed if they were under 18 years and considered “children.” The authors discuss how systematic differences in how pediatric and adult patients may be treated can lead to differences in opioid prescribing.

Based on data from the CMS COVID-19 Nursing Home Database, this study found that more than 20% of nursing homes report a severe shortage of personal protective equipment (PPE) and shortage of staff; rates for staffing and PPE did not improve from May to July of 2020. Nursing homes with COVID-19 cases among residents and staff, and those with lower quality scores, were more likely to report shortages.

The root causes of the opioid epidemic are complex, but inappropriate prescribing of opioids (which includes both prescribing opioids in situations where they are not indicated as well as excessive prescribing for appropriate indications) is a major contributor. Prior studies of outpatient antibiotic prescribing have shown that rates of inappropriate prescribing rise toward the end of clinicians' clinic sessions. This cross-sectional study used data from 5603 primary care physicians for acute painful conditions to analyze whether a similar relationship exists for opioid prescribing. Investigators found that the likelihood of opioid prescribing rose considerably as the workday progressed; clinicians were also more likely to prescribe opioids if their appointments were running late. In contrast, prescriptions for nonopioid therapies did not change in relation to appointment time. Although the magnitude of these effects was smaller than the variation in opioid prescribing rates between physicians found in other studies, these findings confirm that production pressure and decision fatigue contribute to inappropriate prescribing and should be addressed in quality improvement efforts to reduce opioid use.

Timely and accurate diagnosis is a prerequisite for safe and high-quality treatment. This study used data from the Human Diagnosis Project (Human Dx, an online case-solving platform) to examine diagnostic accuracy among individual physicians compared to groups of physicians (collective intelligence). Physicians can enter cases onto the platform or solve cases that others have entered. The more physicians involved in solving a given case, the more likely that the correct diagnosis would be identified. Groups of physicians across specialties outperformed individual subspecialists even for subspecialty-relevant cases. The authors advocate for testing the use of collective intelligence for diagnosis in clinical settings. A related editorial discusses how teaching diagnosis has evolved and the possibility of using collective intelligence to improve diagnostic accuracy. In a previous PSNet interview, Shantanu Nundy, Director of Human Dx, discussed his work with the project.

This study used Medicare data to examine the relationship between potential opioid misuse and opioid overdose. Researchers defined six possible indicators of opioid misuse (e.g., obtaining opioids from more than five prescribers or more than five pharmacies) in a manner conceptually similar to trigger tools. Patients with any of these opioid use triggers were significantly more likely to experience an overdose within the next 6 months. These results provide insight on how best to use data from prescription drug monitoring programs, which are now widely used as a tool in combating the opioid epidemic.

Policy solutions are one approach to help change prescribing and use patterns that have contributed to the opioid epidemic. This commentary describes how a state-level program sought to reduce opioid misuse and highlights the need for effective monitoring to drive policy-focused improvement initiatives.

… Joint Commission discussed his role in the organization. … Barnett ML, Olenski AR, Jena AB. Patient Mortality During …

The opioid epidemic is currently one of the most pressing patient safety challenges, as discussed in a recent Annual Perspective. High-risk prescribing practices by clinicians is one contributing factor in the surge in opioid use among patients. Prior research has shown that patients often receive opioids following low-risk procedures, and they frequently receive opioid prescriptions even after overdosing on these medications. This cohort study found wide variations in opioid prescribing practices among emergency departments, with some physicians prescribing opioids almost three times as often even after controlling for patient characteristics. Notably, patients who received opioids from a high-intensity prescriber were significantly more likely to continue using opioids 12 months later—indicating a possible connection between physician prescribing practices and subsequent opioid addiction. The study confirms that reducing variation in physician prescribing practices should be one component of an overall strategy to address opioid overuse.

Electronic health records (EHRs) offer safety benefits, but the disruption associated with EHR implementation can lead to unintended consequences as well. This observational study sought to determine whether the incidence of adverse patient outcomes (including certain AHRQ Patient Safety Indicators, readmissions, and mortality) was higher at 17 hospitals that were transitioning to a new EHR than in 399 hospitals that did not change their EHR. Investigators found no significant difference between safety outcomes of hospitals with a new EHR and those without a new EHR. This large-scale study across multiple institutions demonstrates that patients' care remains safe during EHR transitions. The authors suggest that these results should allay safety concerns for institutions planning to implement EHRs. A PSNet interview described the challenges associated with EHR transitions.