Rates of prescription opioid misuse and abuse led to recommendations for dose tapering for patients with chronic pain. However, concerns have been raised about the potential harms associated with rapidly decreasing doses or discontinuing opioids. Building on previous research, these researchers used a large claims database to explore the unintended negative consequences of tapering patients on stable, long-term opioid therapy. Findings indicate that opioid tapering was associated with fewer primary care visits, greater numbers of emergency department visits, and reduced adherence to antihypertensive and antidiabetic medications.

Adverse events associated with long-term opioid therapy have led to recommendations for dose tapering for patients with chronic pain. This study assessed the long-term risks of overdose and mental health crisis as a result of dose tapering. Consistent with earlier research on short-term risks, results indicate that opioid tapering is associated with increased risk of adverse events up to 24 months after initiation of tapering.

Medication-assisted treatment (MAT) is increasingly used to treat opioid use disorder (OUD). This study found that providers or practices with higher quality measure scores of MAT continuity (percentage of patients with OUD who had at least 180 days of continuous treatment) had a lower risk of opioid-related adverse events among their patients.

… preferences for various possible related outcomes (e.g., readmissions, reoperation, long-term care stay, death). …

Sudden discontinuation of opioids has been linked to increased patient harm. This observational study evaluated the link between tapering and overdose, and mental health crisis among patients who were receiving long-term opioid therapy. Patients who underwent dose tapering had an increased risk of overdose and mental health crisis compared to those who did not undergo dose tapering. 

… Int J Qual Health Care … Prior research has raised concerns about … PSI measurement with administrative data, manual review of a subsample of charts, and validity adjustment, and found … concerns in estimating adverse event rates. … Boussat B, Quan H, Labarere J, et al. Int J Qual Health Care. Epub 2021 …

… J Med Syst … Clinical decision support (CDS) alerts can … overrides can identify errors. The researchers describe a novel approach to using existing CDS systems to detect … measure dosing errors and clinician-level quality of care. J Med Syst. 2020;44(10):185. Epub 2020/09/09. …

This commentary discusses the challenges associated with detecting and measuring adverse events, the limitations of measurement alone, and the existing methodologies that can be leveraged to improve the accuracy of adverse event detection.

The AHRQ Patient Safety Indicators (PSIs), which are used to screen administrative data for patient safety events, have been revised in response to the new ICD-10 coding system. This study sought to validate the accuracy of ICD-10-based PSIs for detecting postoperative adverse events, compared to the National Surgical Quality Improvement Program reference standard. Although the PSIs had relatively high negative predictive value (meaning that the absence of a PSI meant that the patient likely had not experienced an adverse event), the overall accuracy was not sufficient to warrant using PSIs as the sole strategy to detect adverse events.

This systematic review found that while interventions designed to improve inpatient documentation within electronic health records (EHRs) are highly varied, education and EHR reporting systems seem to be more effective in improving electronic documentation for hospitalized patients than other efforts.

… … BMJ Qual Saf … This study examined the implementation of a tool integrated into the electronic health record to export … high sensitivity and specificity when compared to a chart audit and identified a higher proportion of adverse surgical events than …

… Preventing adverse events after hospital discharge remains a top patient safety priority. In this randomized controlled …

… the International Society for Quality in Health Care … Int J Qual Health Care … For the first time, the World Health Organization ICD-11 will include a taxonomy for quality and safety events . Researchers … detection of errors, adverse events, and near misses on a population level. …

Checklists are widely utilized in health care to promote patient safety. Management of trauma patients is complex, and checklists may facilitate adherence to known standards of care. This pre–post study looked at the impact of the World Health Organization Trauma Care Checklist program across 11 hospitals in 9 countries. Researchers found that adherence to 18 out of 19 care process measures improved after the checklist program was implemented. Although investigators discerned no difference in mortality for the overall study population, they found a 50% reduction in mortality for patients with more severe trauma injuries after implementation of the program. A prior PSNet perspective discussed components of an effective checklist.

AHRQ Patient Safety Indicators (PSIs) have been utilized to identify safety problems and suboptimal care quality in acute care settings using ICD-9 codes in administrative discharge data. Despite limitations in the accuracy of PSIs, they have been widely employed as a quality metric. The implementation of ICD-10 and diagnosis timing codes necessitate development of a new set of PSIs. This consensus and validation study used a Delphi panel process to determine ICD-10 codes associated with safety and quality concerns. Experts grouped the 640 identified diagnostic codes into 18 PSI categories. Application of these novel PSIs in over 10 years of hospital discharge data uncovered safety problems in 5% of hospitalizations. The authors recommend that these proposed PSIs should be further validated using record review or prospective case review.

… BMJ open … BMJ Open … Patient-centeredness is considered a crucial aspect of high quality care. Patient satisfaction …

Patient reports of adverse outcomes are one critical method to detect safety hazards. This study used patient reports of adverse outcomes to develop a framework for identifying adverse events. The authors suggest that patient reports could be used as a trigger tool to prompt review of cases for adverse events.

Suboptimal communication between patients and physicians can result in patients misunderstanding important aspects of their care. This study found that the majority of patients with cancer reported a more optimistic survival prognosis than their oncologists. These findings suggest the need to improve physician–patient communication about prognosis in order to ensure appropriate discussion of treatment decisions and goals.