In response to the increase in opioid deaths, the Centers for Disease Control and Prevention (CDC) released the Guidelines for Prescribing Opioids for Chronic Pain in 2016, with an update released in 2022. This study reports on the CDC Opioid QI Collaborative which was launched to identify successful evidence-based strategies for implementing the guidelines. The challenges and strategies described in the publication can be used by health systems to accelerate implementation of the guidelines.

Diagnostic errors are an emerging area of patient safety research; as such, innovative methods to identify and prevent diagnostic errors are being developed. This commentary describes the development, implementation, and sustainment of a novel method of investigation. The e-Autopsy/e-Biopsy method includes dedicated patient safety staff and volunteer clinical specialists to review events and identify trends. The process is illustrated with three diagnoses: ectopic pregnancy, abdominal aortic aneurysms, and advanced colon cancer.

While falls are common in older adults, there was a 31% increase in death due to falls in the U.S. from 2007-2016, partially associated with the increase in older adults in the population. This mixed methods study looked at the prevalence, risk factors, and contributors to potentially harmful medication dispensed after a fall/fracture of patients using the Potentially Harmful Drug-Disease Interactions in the Elderly (HEDIS DDE) codes. There were 113,809 patients with a first time fall; 35.4% had high-risk medications dispensed after their first fall. Interviews with 22 physicians identified patient reluctance to report falls and inconsistent assessment, and documentation of falls made it challenging to consider falls when prescribing medications.

High reliability organizations encourage staff to self-report errors and hazards for comprehensive review and improvement. Three hospitals in one health system implemented a voluntary error reporting system for clinicians to report their own and others’ clinical errors. Although only 5% of reported errors were physician self-reports, there were still benefits: it captured novel errors, provided a safe space to report those errors, and encouraged secondary insights into causes of the errors.

Older adults taking potentially inappropriate medications (PIMs) are at increased risk of adverse events including falls. Patients and primary care providers described their knowledge and awareness of risk of falls related to PIMs, deprescribing experiences, and barriers and facilitators to deprescribing. Patients reported lack of understanding of the reason for deprescribing, and providers reported concerns over patient resistance, even among patients with falls. Clinician training strategies, patient education, and increased trust between providers and patients could increase deprescribing, thereby reducing risk of falls. 

Adherence to prescribing guidelines for appropriate opioid dosing and duration can decrease the risk of opioid-related harm. In this retrospective analysis of nationally representative outpatient claims data, researchers found that over a 4-6 month period, 28% of Medicaid and 35% of privately-insured patients had at least one pain-related visit and 35% of all enrollees had one or more opioid prescriptions. Opioid prescribing rates varied depending on the specific medical indication and the patient’s opioid prescribing history. The researchers found that prescribing rates of many pain medical indications were not always aligned with current guidelines. For example, patients with chronic non-cancer pain conditions undergoing long-term opioid therapy were commonly prescribed daily doses above the threshold for which adverse events, such as overdose, are increased.

This Centers for Disease Control and Prevention report provides drug and opioid overdose death figures for 2016. The rate of overdose deaths continues to rise, with the largest increase due to synthetic opioids such as fentanyl. The report calls for enhancing prevention and response measures, including the use of naloxone.

The opioid epidemic continues to be a pressing patient safety challenge in the United States. Many efforts have been implemented to curb opioid prescribing, such as policy initiatives and targeted feedback to individual clinicians. A major initiative was the release of the Centers for Disease Control and Prevention (CDC) guidelines for prescribing opioids for patients with chronic pain. These guidelines (which do not apply to patients with cancer or patients receiving palliative care) called for initially using nonopioid medications and nonpharmacologic approaches to chronic pain before using opioids, prescribing immediate-release instead of long-acting medications, and avoiding use of other sedating medications. This study examined trends in opioid prescribing rates before and after the CDC guidelines were released. Investigators found that opioid prescribing overall has decreased between 2012 and 2017, but the rate of decline increased after dissemination of the CDC guidelines. Perhaps the most notable finding is that the number of high-dose opioid prescriptions declined by nearly 50% over the study period (from 683 to 356 prescriptions per 100,000 adults). An Annual Perspective discussed the causes and potential solutions to opioid overprescribing.

Opioids are high-risk medications and variation in prescribing practices is common. This retrospective pre–post intervention study describes a large health care system's initiative to improve opioid prescribing, patient monitoring, and care coordination for patients with chronic pain.

This analysis of retail prescription data revealed that opioid prescribing has declined from a peak in 2010, but it remains higher than in 1999. Increased rates of opioid prescribing occurred in areas that are not urban, have a greater proportion of white populations, and higher unemployment and Medicaid enrollment. These results are consistent with prior studies about the opioid epidemic.

Although diagnostic errors cause considerable morbidity and mortality, thus far organizations have focused on preventing errors that are more easily measured. This commentary provides two examples of organizational approaches to minimizing diagnostic error. In one, Maine Medical Center established a voluntary reporting system for diagnostic error coupled with a revised root cause analysis process to determine both cognitive and systems causes of these errors. In the other example, the Kaiser Permanente system leveraged their electronic medical record to establish electronic "safety nets" to identify patients at risk of diagnostic error. These mainly focused on ensuring appropriate follow-up of abnormal lab tests (particularly cancer screening tests) and sufficient monitoring of high-risk medications. As failure to appropriately follow-up on lab abnormalities is a common source of patient harm in ambulatory care, this system—which identified thousands of patients requiring urgent follow-up—likely averted many cases of preventable harm. An accompanying editorial by Dr. Hardeep Singh encourages health care organizations to develop processes for examining missed opportunities for making timely diagnoses.