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.

… and more appropriate prescribing. … Galanter W, Eguale T, Gellad W, et al. Personal formularies of primary care …

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.

To address a need for national guidance on pain management practices during the COVID-19 pandemic, a panel including pain management experts from the military, Veterans Health Administration, and academia was convened. The proposed framework includes guidance for pain practitioners and institutions to balance risk mitigation for both providers and patients, staffing plans to prevent or minimize exposure of staff and patients, use of telehealth for pain management, conservation of resources, and access to pain management services. Any pain management plan must consider many facets including patients’ clinical circumstances and providers’ wellbeing.

Guidelines recommend safe opioid prescribing but also warn against sudden tapering or discontinuation of opioids, which can lead to harm among patients physically dependent on the medications. Using data from the Veterans Heath Administration (VA), this observational study examined the association between opioid treatment cessation and death from overdose or suicide. Researchers found an increased risk of death from overdose or suicide regardless of the length of treatment; the risk of death increased with longer treatment duration. The authors recommend that efforts to improve opioid safety include assessing risks that may place patients at risk for overdose or suicide whether they continue or stop opioid treatment.

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.

Encouraging adverse event reporting among health care providers, including medical trainees, is critical to improving patient safety. This qualitative study convened focus groups to elucidate what factors support event reporting among medical residents. Residents were more likely to use reporting tools when they had received training about the process, and identified specific interventions, to encourage reporting, such as role modeling by faculty.

… Journal of general internal medicine … J Gen Intern Med … State-based prescription drug monitoring …

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.

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