Potentially inappropriate opioid prescribing increases risk of patient harm and misuse. This study used videos and written vignettes to explore how patient race and previous opioid misuse behaviors impact providers’ risk assessment for future prescription opioid-related problems. Findings indicate that black patients were perceived by both residents and fellows to be at greater risk for future adverse events and diversion regardless of previous misuse history, suggesting that racial minorities with chronic pain may be vulnerable to unintended consequences of public health efforts to reduce opioid prescribing.

Many efforts have been implemented to address the opioid epidemic, such as guidelines and targeted communications to prescribing clinicians. This commentary summarizes findings of an expert consensus panel exploring the impact of the Centers for Disease Control and Prevention opioid guideline, implementation challenges, and unanticipated effects. The panel generally supported the guideline and suggested tactics to avoid unintended consequences, including engaging patients directly in pain therapy changes and improving management of opioid use disorder.

… Commission journal on quality and patient safety … Jt Comm J Qual Patient Saf … This interview study examined …

Safe diagnosis is a complex challenge that requires multidisciplinary approaches to achieve lasting improvement. The authors worked with a multidisciplinary panel to build a 10-element framework outlining steps that support conservative diagnosis. Recommendation highlights include a renewed focus on history-taking and physician examination, as discussed in a PSNet perspective. They also emphasize the importance of continuity between clinicians and patients to build trust and foster timely diagnosis. Taken together with recommendations for enhanced communication between specialist and generalist clinicians and more judicious use of diagnostic testing, this report is a comprehensive approach to reducing overdiagnosis and overtreatment.

Opioid medication use is associated with an increased risk of adverse drug events, including overdose-related deaths. A previous study demonstrated that patients prescribed higher doses of opioid medications or longer duration of opioid therapy were more likely to continue to use opioid medications over time. Although recent opioid prescribing guidelines recommend reducing doses and limiting duration of therapy, the impact of adherence to these guidelines on patient outcomes remains unknown. This systematic review included 67 studies involving dose reduction or discontinuation of long-term opioid therapy in patients being treated for chronic pain. Researchers conclude that the evidence on the effectiveness of interventions aimed at decreasing long-term opioid therapy and reducing doses on improving patient outcomes such as pain, function, and quality of life is limited. An accompanying editorial comments on the challenges associated with chronic pain management and acknowledges the need for further research in this area.

Opioid medications are associated with an increased risk of adverse drug events, including overdose. Certain populations may be at greater risk for adverse outcomes from opioids and may be more likely to receive them. This study looked at health insurance claims data for more than 10 million patients who filled opioid prescriptions. Researchers found that those with underlying psychiatric and behavioral conditions (including opioid and nonopioid substance use disorders) were more likely to receive long-term opioid therapy than patients without such conditions.

Severe hospital-acquired pressure ulcers are considered a never event, and they result in loss of payment for the hospitalization according to Centers for Medicare and Medicaid Services (CMS) policy. Bundled interventions have shown success at preventing these complications in research studies, but broader data on their effectiveness have been lacking. This study used administrative data to demonstrate that adoption of evidence-based strategies and implementation of the CMS policy was associated with a decrease in the incidence of hospital-acquired pressure ulcers in academic medical centers.

This auditory perception study explored factors that led to erroneous verbal orders.