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Patient Safety Primers
Over the past decade, the opioid epidemic has taken the lives of tens of thousands of patients. Much of the epidemic can be ascribed to inappropriate prescribing of opioids, despite knowledge of the safety risks they pose. Current efforts to improve opioid safety have primarily focused on reducing opioid prescribing.
Journal Article > Study
Fialová D, Topinková E, Gambassi G, et al. JAMA 2005;293:1348-1358.
This retrospective cross-sectional study of nearly 3000 elderly patients aimed to estimate the prevalence of inappropriate medication use. Investigators studied participants from several European cities and found that nearly 20% used at least one inappropriate medication. Discussion includes a detailed table comparing three different criteria systems for identifying inappropriate medications in the elderly as well as comparisons of the findings in this study with those in the United States. The authors also describe noted regional differences within European cities and report a number of factors associated with inappropriate use, including poor economic situation, polypharmacy, and depression. They authors call for greater regulatory measures and uniformity within the European Union to improve prescribing habits for the elderly.
Legislation/Regulation > Federal Legislation
HR 2234, 109th Cong, 1st Sess (2005).
This bill, which garnered bipartisan support, proposes developing health information technology networks (known as "Regional Health Information Organizations," or RHIOs) with a strong focus on state- and community-based efforts. It is presently under consideration in the United States House of Representatives.
Ostrom CM. Seattle Times. June 22, 2006:B1.
This article reports on a Washington state law that prevents pharmacists from accepting prescriptions that are handwritten unless they are very clearly printed.
Evanston, IL: Office of the Governor; July 13, 2006.
This news release announces the governor's plans to improve patient safety in Illinois, including the use of e-prescribing by all providers and a Division of Patient Safety within the state public health department.
Journal Article > Study
Perceptions of standards-based electronic prescribing systems as implemented in outpatient primary care: a physician survey.
Wang CJ, Patel MH, Schueth AJ, et al. J Am Med Inform Assoc. 2009;16:493-502.
Investigating the prevalence and causes of prescribing errors in general practice: The PRACtICe Study.
Avery T, Barber N, Ghaleb M, et al. London, UK: General Medical Council; May 2, 2012.
Examining prescription errors in general practices in England, this report suggests that information technology and incident reporting could address issues that persist since an earlier study.
Journal Article > Study
Which clinical errors lead to the referral of UK paediatricians to the National Clinical Assessment Service?
Raine J, Scarrott D. Eur J Pediatr. 2012;171:1449-1452.
This study discovered that child protection cases and prescribing errors were the most common reasons pediatricians were referred to a governing body overseeing provider performance concerns.
NCPDP Recommendations and Guidance for Standardizing the Dosing Designations on Prescription Container Labels of Oral Liquid Medications Version 1.0.
Scottsdale, AZ: National Council for Prescription Drug Programs; March 2014.
This white paper describes recommendations to reduce risks around oral liquid medication administration, including assigning a standard unit of measure (milliliters), using leading zeroes before decimal points (for amounts smaller than one), and ensuring that dosing mechanisms and container labels employ corresponding units of measure.
Journal Article > Government Resource
Characteristics of initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015.
Shah A, Hayes CJ, Martin BC. MMWR Morb Mortal Wkly Rep. 2017;66:265-269.
Opioid use has become a growing patient safety concern. Recent studies have documented wide variation in opioid prescribing for acute pain and a significant rate of chronic opioid use after patients receive a first prescription for an acute indication. This retrospective medical record review study identified risk factors for remaining on an opioid medication for more than 1 year following their initial prescription. Older, female, and publicly or self-insured patients were more likely to remain on an opioid compared with younger, male, and privately insured patients. Patients started on higher doses (cumulative dose ≥ 700 mg morphine equivalent), provided prescriptions with longer duration (more than 10 days), or given 3 or more prescriptions for opioids were most likely to continue to use opioid medications 1 year later. The authors recommend prescribing fewer than 7 days of opioids for acute pain and adhering to the Centers for Disease Control and Prevention guideline for opioid use to improve prescribing practices.
Dembosky A. All Things Considered and KQED. January 23, 2019.
Policy, practice, and communication strategies have been implemented in an effort to stem the opioid crisis and prescribing activities that contribute to misuse. This news article and accompanying webcast discuss an initiative in California that sends letters to prescribers whose patients have died due to opioid overdose. The piece outlines unintended consequences associated with the practice, including clinician reluctance to prescribe opioids for pain. An Annual Perspective discussed the patient safety aspects of the opioid epidemic.
Journal Article > Study
Jayawardhana J, Abraham AJ, Perri M. Am J Manag Care. 2019;25:e98-e103.
Inappropriate opioid prescribing increases risk of patient harm and misuse. In this retrospective study, researchers examined pharmacy claims data on Georgia Medicaid patients without cancer who were prescribed opioids. They found a higher odds of death among opioid users with at least a single incidence of inappropriate opioid prescribing compared to opioid users who did not experience inappropriate prescribing.
Journal Article > Commentary
Rubin R. JAMA. 2019 Apr 29; [Epub ahead of print].
Patients with chronic pain can experience unintended consequences related to prescription limitation policies implemented to address the opioid epidemic. This commentary offers insights from primary care providers and regulators regarding the difficulty of managing opioid prescriptions to limit misuse while effectively treating pain.
Journal Article > Review
Neuman MD, Bateman BT, Wunsch H. Lancet. 2019;393:1547-1557.
The overprescribing of opioids for postsurgery pain can increase the potential for opioid dependence, misuse, and harm. Discussing this worldwide patient safety concern, this commentary summarizes clinician, patient, and systemic factors that contribute to the problem and outlines efforts to address the issue while enabling clinicians to provide safe pain therapy to patients.