The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.
Dowell D, Ragan KR, Jones CM, et al. MMWR Recomm Rep. 2022;71:1-95.
In 2016, the Centers for Disease Control and Prevention (CDC) released guidelines for safe opioid prescribing for chronic pain. Based on an updated evidence review, the CDC has revised the guidelines and released the Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022, include recommendations for outpatient acute, subacute, and chronic opioid use. The twelve recommendations fall into four broad categories: determining whether or not to initiate opioids for pain; selecting opioids and determining opioid dosages; deciding duration of initial opioid prescription and conducting follow-up; and assessing risk and addressing potential harms of opioid use. The CDC will update and develop tools and resources to support dissemination of these guidelines.
The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care, or for patients in the emergency department or admitted to the hospital.
Ayalew MB, Spark MJ, Quirk F, et al. Int J Clin Pharm. 2022;44:860-872.
Patients with diabetes, particularly those taking multiple medications, are at increased for medication adverse events. In this review of nearly 200 studies of potentially inappropriate prescribing (PIP) for patients with diabetes, several types of PIPs occurred: contraindication, omission, incorrect dosing, drug-drug interaction, inappropriate drug selection, and unnecessary drug therapy.
Butler AM, Brown DS, Durkin MJ, et al. JAMA Netw Open. 2022;5:e2214153.
Inappropriately prescribing antibiotics for non-bacterial infections remains common in outpatient settings despite the associated risks. This analysis of antibiotics prescribed to more than 2.8 million children showed more than 30% of children with bacterial infection, and 4%-70% of children with viral infection were inappropriately prescribed antibiotics. Inappropriate prescribing led to increased risk of adverse drug events (e.g., allergic reaction) and increased health expenditures in the following 30 days.
Ryser MD, Lange J, Inoue LYT, et al. Ann Intern Med. 2022;175:471-478.
Overdiagnosis of breast cancer can result in overtreatment and cause physical and emotional harm. Based on data from 35,986 women in a US-based breast cancer screening registry, this study estimates that15.4% of screen-detected cancers are overdiagnosed (i.e., detecting indolent preclinical cancer or detecting progressive preclinical cancer among women who would have died of unrelated causes before clinical diagnosis), which is higher than previous estimates. The authors suggest that data can improve shared decision-making between patients and physicians.
Clift K, Macklin-Mantia S, Barnhorst M, et al. J Prim Care Community Health. 2022;13:215013192110697.
Knowing a patient’s individual risk factors for developing cancer can assist patients and providers in deciding when to screen for cancers and can prevent both overtreatment and delays in care. This study compared patient-reported family history of cancer in the electronic health record (EHR) and family history collected using a focused questionnaire. Results showed inconsistencies between the two, especially for patients with more complicated family histories.
Korenstein D, Harris RP, Elshaug AG, et al. J Gen Intern Med. 2021;36:2105-2110.
Provider and patient underestimation of harms of tests and treatments may lead to over treatment. This article presents seven domains of harm of tests and treatment which warrant comprehensive research: (1) physical impairment, (2) psychological distress, (3) social disruption, (4) disruption in connection to healthcare, (5) labeling, (6) financial impact, and (7) treatment burden. Research is especially important in vulnerable patient populations.
Prior research found significant confusion among physicians in understanding Physician Orders for Life-Sustaining Treatment (POLST) documents, which can lead to errors. This study found that emergency medical services (EMS) personnel did not exhibit adequate understanding of all POLST or living will documents either. The researchers propose that patient video messaging can increase clarity about treatment, and preserve patient safety and autonomy.
Hahn EE, Munoz-Plaza CE, Lee EA, et al. J Gen Intern Med. 2021;36:3015-3022.
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.
Zhou J, Calip GS, Rowan S, et al. Pharmacotherapy. 2020;40:992-1001.
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.
Bloomfield HE, Greer N, Linsky AM, et al. J Gen Intern Med. 2020;35:3323-3332.
Deprescribing is one strategy to reduce polypharmacy among older adults. This systematic review found that medication deprescribing interventions (particularly those involving comprehensive medication review) may provide small reductions in mortality and use of potentially inappropriate medications among community-dwelling older adults.
Liew TM, Lee CS, Goh SKL, et al. Age Ageing. 2020.
Potentially inappropriate prescribing in older adults can lead to adverse health outcomes and worsened health-related quality of life. This meta-analysis estimated the prevalence of potentially inappropriate prescribing in older adults to be 3.3%, and estimated that potentially inappropriate prescribing explains 7.7 to 17.3% of adverse outcomes affecting older adults in primary care. Interventions to prevent potentially inappropriate prescribing should be prioritized as a key strategy to reduce medication-related harm along older adults in primary care settings.
Rogero-Blanco E, Lopez-Rodriguez JA, Sanz-Cuesta T, et al. JMIR Med Inform. 2020;8.
Older patients are vulnerable to adverse drug events due to comorbidities and polypharmacy. This cross-sectional study from Spain reviewed prescriptions for 593 older adults aged 65-75 years with multiple comorbidities and documented polypharmacy to estimate the prevalence of potentially inappropriate prescribing using the STOPP and Beers Criteria. Potentially inappropriate prescribing was detected in over half of patients. The most frequently detected inappropriate prescriptions were for prolonged use of benzodiazepines (36% of patients) and prolonged use of proton pump inhibitors (45% of patients). Multiple risk factors associated with potentially inappropriate prescribing were identified, including polypharmacy and use of central nervous system drugs.
Davies LE, Spiers G, Kingston A, et al. J Am Med Dir Assoc. 2020;21:181-187.
In this systematic review, the authors synthesized evidence on polypharmacy in older adults and subsequent adverse health outcomes, as well as impacts on social outcomes (e.g., loneliness), medication management (e.g., nonadherence) and healthcare utilization. Results from twenty-six reviews encompassing 230 unique studies showed that polypharmacy is associated with increased hospitalizations and inappropriate prescribing. The authors describe conflicting evidence on associating polypharmacy with adverse outcomes, including adverse drug events and disability. Evidence on the adverse social outcomes, as well as harms in adults 85 years and older, was limited.
Medical overuse is a well-recognized patient safety challenge. This review expands upon prior research highlighting the top 10 studies published in 2018 that may help reduce overuse in pediatrics. Highlighted articles describe both established practices that may warrant deimplementation (such as routine outpatient opioid prescribing) and emerging practices that merit greater inspection or discouragement from widespread adoption (such as post-discharge nurse-led home visits).
Polypharmacy is a known contributor to adverse drug events in older adults. This story discusses strategies such as brown bag reviews and deprescribing to minimize overprescribing that could contribute to harm.
Huang C-H, Umegaki H, Watanabe Y, et al. PLOS ONE. 2019;14:e0211947.
Various tools for identifying potentially inappropriate medications (PIMs) have been developed. This 5-year prospective cohort study of 196 elderly patients receiving home-based medical services in Japan compared the use of two tools for identifying PIMs, the American Geriatrics Society’s Beers Criteria and the relatively new Screening Tool for Older Person’s Appropriate Prescriptions for Japanese (STOPP-J), to determine the impact of PIMs on hospitalization and mortality rates. PIMs categorized by STOPP-J were associated with hospitalization and mortality, whereas Beers Criteria PIMs were associated with hospitalization only after excluding proton pump inhibitors.
Brownlee S; Garber J. Brookline, MA: Lown Institute; 2019.
Overprescribing is a common problem that contributes to patient harm. This report examines financial, clinical, and societal trends of medication overuse and inappropriate polypharmacy in older Americans. A culture of prescribing, deficits in information and knowledge, and fragmented care contribute to the problem. The report provides interventions to improve the safety of prescribing, including developing deprescribing guidelines, raising awareness among providers and patients about medication overload, and implementing team-based care models.
Prescribing unnecessary antibiotics increases the risk of resistant infections and can lead to patient harm. In this cross-sectional study, researchers found that 23% of the 15,455,834 outpatient antibiotic prescriptions filled among a cohort of 19.2 million patients over a 1-year period were consistent with inappropriate prescribing.
Thorpe KE, Joski P, Johnston KJ. Health Aff (Millwood). 2018;37:662-669.
Infections with antibiotic-resistant organisms are increasingly common in hospitals and ambulatory care, primarily driven by overuse of antibiotics for treatment of nonbacterial illnesses. This economic analysis found that antibiotic-resistant infections have doubled in incidence since 2002, and they add approximately $1,400 to the cost of care for each patient with an antibiotic-resistant infection. The study was performed using data from the Medical Expenditure Panel Survey, which is conducted by AHRQ. This survey does not include data on institutionalized adults, such as residents of long-term care facilities. Since antibiotic-resistant infections are common in these patients, this study may actually underestimate the total economic burden of these infections. The devastating effects of an antibiotic-resistant infection for a health care practitioner were vividly illustrated in a PSNet perspective.
Ducoffe AR, York A, Hu DJ, et al. Pain Med. 2016;17:2291-2304.
Accidental overuse of opioid medications in the ambulatory environment is a prominent patient safety concern. This commentary reviews a national plan to curb adverse drug events and applies those recommendations to guide efforts to improve opioid safety.
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