Search results for "Ordering/Prescribing Errors"

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.

Concurrent use of opioids and benzodiazepines increases risk for adverse drug events. This retrospective analysis of medical claims found that the risk of emergency department visit was greater for patients with concurrent use of these two medication classes compared to patients on opioids alone. This finding supports the recommendation to avoid coprescribing these two medication classes.

Opioid-related harm, including overdose deaths, has reached epidemic proportions. This study used a difference-in-differences analysis to examine whether a policy approach could reduce harm from opioid misuse. Investigators compared states with and without mandated provider review of drug monitoring data. In states with mandated review, opioid prescribers must check whether patients are receiving opioids from multiple prescribers and identify the total prescribed opioid dose. States with mandated review policies had fewer opioid overdose deaths and lower amounts of opioids prescribed than states without mandated prescriber review. These results are consistent with a prior study that established the benefit of prescription drug monitoring programs. The authors assert that despite the effectiveness of this policy, more interventions are needed to enhance opioid safety, as suggested in a recent study. A previous WebM&M commentary described opioid-related harm.

Misuse of prescription opioids represents a serious patient safety issue. In this study, investigators examined opioid prescribing to Medicare beneficiaries upon hospital discharge. They found that new opioid use was common after discharge and that prescribing rates varied widely across hospitals.

Concerns about patient harm from prescription opioid misuse are increasing in the United States. This website provides guidelines for use of opioid medications and information to raise awareness about the need to improve physicians' prescribing decisions and patients' medication use.

Opioid medications are a known safety hazard, and overdoses of opioid medications are considered an epidemic in the United States. This cohort study examined treatment patterns for patients who had experienced a nonfatal opioid overdose. More than 90% of patients were prescribed opioids following such events, and within 2 years up to 17% of those patients experienced another overdose event. An accompanying editorial notes the lack of systems to ensure clinicians' awareness of patients' opioid overdoses and recommends enhancing training and support so that clinicians are prepared to treat chronic pain and addiction. New approaches are urgently needed given this crisis in medication safety. A previous WebM&M commentary discussed the challenges of prescribing safely for chronic opioid users.

Overprescribing can increase risk of dementia, particularly among older patients. This commentary describes an incident involving a patient with moderate dementia that worsened when opioids were prescribed following a fall. After a geriatrician evaluated the patient and suspected polypharmacy, the drugs were stopped, caregivers were educated about how to treat the patient, and the patient improved. Highlighting the importance of environmental interventions in treating this patient, the author reviews strategies to address neuropsychiatric symptoms of dementia.

This cross-sectional study found that more than one quarter of opioid prescriptions at a teaching hospital contained at least one error.

This news story reports on the death of a pediatric patient after he was mistakenly prescribed fentanyl for pain management following a dental procedure. The hospital disclosed the error and has publicly apologized.

Medication errors are a common problem in pediatric outpatients, and high-alert medications such as opioid analgesics are a major cause of emergency department visits in both children and adults. This study evaluated the quality of analgesic prescriptions in patients being discharged from a pediatric teaching hospital. Most prescriptions contained at least one error, including frequent use of error-prone abbreviations and failure to use weight-based dosing, and 3% of prescriptions were judged to have the potential for serious patient harm. Computerized provider order entry (CPOE) has been advocated as a means of preventing medication errors in children, but in a prior study, CPOE actually failed to reduce dosing errors in children.

Adverse drug events related to opioid medications are a significant patient safety concern. This analysis of insurer claims data demonstrated that changing opioid prescribing requirements, including implementing patient–provider agreements, requiring prior authorization, and enforcing quantity limits, led to a decline in opioid prescribing. The authors recommend that insurers implement policies from the Centers for Disease Control and Prevention opioid guidelines to improve safety.

Opioid misuse is at epidemic proportions in the United States. This commentary advocates for physicians who recognize that their patients are misusing opioids to carefully approach changes in treatment strategies. Providers should adjust their prescribing behavior, counseling skills, and use of electronic health records to determine an effective care plan to address the patient's pain.

Inappropriate opioid use in ambulatory and hospital environments is often associated with patient harm. This review discusses guidelines and current evidence to inform assessment and monitoring for patients using this high-alert medication.

Drug shortages can result in safety consequences, as studies have shown a higher rate of treatment failure and increased adverse events associated with unavailability of first-line therapies. However, this study did not find any change in adverse events in pediatric intensive care unit patients during a shortage of commonly used sedatives and injectable opioid pain medications. The authors note that advance warning of the shortage and development of standardized algorithms for drug substitution may have mitigated the potential safety hazards.

A quality improvement project that included personalized, real-time feedback on medication prescribing errors successfully reduced narcotic prescribing errors and identified numerous avenues for system improvement.

A comprehensive quality improvement intervention resulted in a significant reduction in adverse drug events due to opioid pain medications, particularly in the immediate postoperative period.

This study categorized more than 12,000 medication-related incidents in an intensive care unit and found that the greatest number resulted during administration. Morphine was the most common medication involved.

This announcement alerts parents and health care professionals about the potentially fatal dangers of Tussionex Pennkinetic Extended-Release Suspension, a prescription cough medicine that should not be used in children younger than 6 years.

This announcement provides specific instructions on safe prescribing of a cancer pain medication in response to several patient deaths associated with off-label use.

This article discusses inappropriate prescribing of medication patches for acute pain management and provides strategies for minimizing problems associated with their use.