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Search results for "United States of America"

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Journal Article > Study

Postoperative opioid prescribing and the pain scores on Hospital Consumer Assessment of Healthcare Providers and Systems survey.

Lee JS, Hu HM, Brummett CM, et al. JAMA. 2017;317:2013-2015.

The opioid crisis is one of the nation's most pressing patient safety problems. Concern has been raised that overprescribing of opioids may be an unintended consequence of efforts to improve patient satisfaction. However, this Michigan study found no relationship between postoperative opioid prescribing and patient satisfaction scores, indicating that efforts to reduce opioid prescribing may not adversely affect patient satisfaction.

Journal Article > Study

New persistent opioid use after minor and major surgical procedures in US adults.

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Brummett CM, Waljee JF, Goesling J, et al. JAMA Surg. 2017 Apr 12; [Epub ahead of print].

Opioid medication use represents a significant safety problem in the United States. Overprescribing by providers is one factor contributing to the widespread use of opioids. Reducing inappropriate prescribing may help improve patient safety. Using claims data for 36,177 patients, investigators sought to better characterize new and persistent opioid use after surgery, defined as filling an opioid prescription between 90 and 180 days postoperatively. Although there was no major difference in persistent opioid use between those who underwent minor surgical procedures and those who underwent major surgical procedures, results demonstrated that opioid use persisted in greater frequency after surgery among patients with behavioral, pain, and substance use disorders. A recent PSNet perspective discussed patient safety with regard to opioid medications.

Newspaper/Magazine Article

The opioid crisis: can improving diagnosis help solve the problem?

Carr S. ImproveDx. April 2017;4:1-4.

The opioid epidemic has been widely discussed, but little research has examined how misdiagnosis can contribute to the problem. This newsletter article suggests that addressing bias, improving diagnosis, and providing pain management training for primary care providers could augment opioid safety.

Journal Article > Study

Prescription opioid exposures among children and adolescents in the United States: 2000–2015.

Allen JD, Casavant MJ, Spiller HA, Chounthirath T, Hodges NL, Smith GA. Pediatrics. 2017;139:e20163382.

Opioid use remains a high priority safety issue. This retrospective study of data from the National Poison Data System reveals that opioid ingestions by children increased from 2000–2009 and then began to decline. Hydrocodone was the most common opioid implicated in these cases, and adolescents were most likely to experience severe harm.

Journal Article > Study

Trends in medical and nonmedical use of prescription opioids among US adolescents: 1976–2015.

McCabe SE, West BT, Veliz P, McCabe VV, Stoddard SA, Boyd CJ. Pediatrics. 2017;139:e2016-e2387.

Opioid use is a patient safety epidemic. This survey of high school seniors in the United States found that prescription opioid use usually precedes nonmedical opioid use, suggesting that improving prescribing practices in accordance with the recent Centers for Disease Control and Prevention guideline is important to address medical and nonmedical opioid use.

Journal Article > Government Resource

Characteristics of initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015.

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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.

Journal Article > Study

Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis.

Sun EC, Dixit A, Humphreys K, Darnall BD, Baker LC, Mackey S. BMJ. 2017;356:j760.

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.

Journal Article > Commentary

Addressing the opioid epidemic in the United States: lessons from the Department of Veterans Affairs.

Gellad WF, Good CB, Shulkin DJ. JAMA Intern Med. 2017;177:611-612.

Opioid medications are a known safety hazard, and overdoses of opioid medications are considered an epidemic in the United States. This commentary discusses US Veterans Affairs health system initiatives that focus on education, prescription monitoring, pain management, and use of guidelines to reduce risks associated with opioids.

Journal Article > Study

Opioid-prescribing patterns of emergency physicians and risk of long-term use.

Barnett ML, Olenski AR, Jena AB. N Engl J Med. 2017;376:663-673.

The opioid epidemic is currently one of the most pressing patient safety challenges, as discussed in a recent Annual Perspective. High-risk prescribing practices by clinicians is one contributing factor in the surge in opioid use among patients. Prior research has shown that patients often receive opioids following low-risk procedures, and they frequently receive opioid prescriptions even after overdosing on these medications. This cohort study found wide variations in opioid prescribing practices among emergency departments, with some physicians prescribing opioids almost three times as often even after controlling for patient characteristics. Notably, patients who received opioids from a high-intensity prescriber were significantly more likely to continue using opioids 12 months later—indicating a possible connection between physician prescribing practices and subsequent opioid addiction. The study confirms that reducing variation in physician prescribing practices should be one component of an overall strategy to address opioid overuse.

Journal Article > Commentary

Opioids for pain management in older adults: strategies for safe prescribing.

Davies PS. Nurse Pract. 2017;42:20-26.

Use of opioids for pain management in older adults can contribute to various problems, including fall-related injury and delirium. This commentary discusses the role of nurse practitioners as prescribers of opioids and offers practice recommendations to reduce risks.

Journal Article > Study

Development and applications of the Veterans Health Administration's Stratification Tool for Opioid Risk Mitigation (STORM) to improve opioid safety and prevent overdose and suicide.

Oliva EM, Bowe T, Tavakoli S, et al. Psychol Serv. 2017;14:34-49.

Opioid-related harm is an urgent patient safety priority. Identifying patients at higher risk of harm is a critical aspect of opioid safety. This quality improvement team developed a predictive model, based on electronic health record data, to identify high-risk opioid users in order to provide targeted monitoring and intervention via a clinical decision support tool. The model included known risk factors for opioid-related harm, such as type of medication, dose, and coprescribed sedating medications as well as medical and mental health conditions. Investigators developed and validated the model using data from 2010 and tested its ability to predict overdose or suicide attempt in 2011. The model successfully and prospectively identified patients at risk for suicide attempt or overdose. They then used the electronic health record to provide physicians with an overdose or suicide risk estimate and a checklist of risk mitigation strategies at the point of care. The authors suggest that further study of the implementation of this risk mitigation strategy in primary care is needed.

Journal Article > Study

Impact of the Opioid Safety Initiative on opioid-related prescribing in veterans.

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Lin LA, Bohnert AS, Kerns RD, Clay MA, Ganoczy D, Ilgen MA. Pain. 2017;158:833-839.

Opioids are known to be high-risk medications, and unsafe prescribing practices are common. This intervention at Veterans Affairs medical centers used an electronic dashboard to provide feedback to clinicians about high-risk opioid prescribing. Local champions implemented the dashboard tool and spearheaded safer opioid prescribing. Using an interrupted time series analysis, researchers determined that the intervention reduced two unsafe prescribing practices: high-dose opioid prescriptions and concurrent use of opioids and benzodiazepines. The authors suggest that this type of large-scale intervention could be applied in other health care systems to enhance opioid safety. A recent Annual Perspective discussed the extent of harm associated with opioid prescribing and described promising practices to foster safer opioid use.

Journal Article > Government Resource

Increases in drug and opioid overdose deaths—United States, 2000–2015.

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Rudd RA, Seth P, David F, Scholl L. MMWR Morb Mortal Wkly Rep. 2016;65:1445-1452.

Opioid medications are frequently associated with adverse drug events in inpatient and outpatient settings. This surveillance report from the Centers for Disease Control and Prevention demonstrated that the magnitude of patient harm from opioid use is growing rapidly. Opioid overdose deaths are increasing each year, through 2015, and current rates are the highest ever recorded. The types of opioids most commonly involved in overdose deaths are natural and semisynthetic opioids, which are often prescribed as pain relievers. The authors suggest that the adoption of new prescribing guidelines and more widespread use of the opioid reversal agent naloxone will help address this growing epidemic. An earlier version of this article included data through 2014. A previous WebM&M commentary described a fatal opioid overdose.

Book/Report

Prescription Drug Monitoring Programs: Evidence-based Practices to Optimize Prescriber Use.

Philadelphia, PA: Pew Charitable Trusts and Institute for Behavioral Health, Heller School for Social Policy and Management at Brandeis University; 2016.

Drug monitoring systems can help track opioid prescription activity to mitigate the opioid crisis. Highlighting the value of these state-sponsored programs to reduce overprescribing, this report recommends eight practices to optimize the use of prescription drug monitoring programs and review state adoption of them. The strategies include simplifying the prescriber enrollment process and integrating health information technology.

Book/Report

Opioid-Related Inpatient Stays and Emergency Department Visits by State, 2009–2014.

Weiss AJ, Elixhauser A, Barrett ML, Steiner CA, Bailey MK, O'Malley L. HCUP Statistical Brief #219. Rockville, MD: Agency for Healthcare Research and Quality; December 2016.

Opioids are known to be high-risk medications, and their misuse is an increasingly recognized patient safety problem. This data analysis from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project delineates trends in opioid-related hospitalizations by state between 2005 and 2014. Both hospital stays and emergency department visits related to opioids have been increasing every year, paralleling trends in opioid overdose deaths. There was substantial variation across states, and the overall rate of opioid-related inpatient stays was 225 per 100,000 population for 2014. These data underscore the need to improve the safety of opioid use to prevent morbidity and mortality.

Journal Article > Study

Healthcare system-wide implementation of opioid-safety guideline recommendations: the case of urine drug screening and opioid-patient suicide- and overdose-related events in the Veterans Health Administration.

Brennan PL, Del Re AC, Henderson PT, Trafton JA. Transl Behav Med. 2016;6:605-612.

Opioids are considered high-risk medications and overdoses are common. Guidelines have been developed to facilitate safe prescribing practices. This study across 141 facilities within the Department of Veterans Affairs (VA) health system demonstrated that as adherence to urine drug screening guidelines increased from 2010 to 2013, the risk of suicide and overdose events among VA patients receiving prescription opioids decreased over the same period. The authors conclude that opioid therapy guidelines may have a positive impact on patient safety.

Journal Article > Commentary

National Action Plan for Adverse Drug Event Prevention: recommendations for safer outpatient opioid use.

Ducoffe AR, York A, Hu DJ, Perfetto D, Kerns RD. 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.

Tools/Toolkit > Government Resource

Turn the Tide Rx.

United States Office of the Surgeon General.

Large-scale and individualized strategies are needed to address opioid misuse. This website provides resources related to a national initiative to improve opioid prescribing practices by obtaining physician commitment to adhere to guidelines and screening methods.

Journal Article > Commentary

Inappropriate opioid dosing and prescribing for children: an unintended consequence of the clinical pain score?

Voepel-Lewis T, Malviya S, Tait AR. JAMA Pediatr. 2017;171:5-6.

Opioid prescribing is gaining attention as a high-risk activity in both general and pediatric care. This commentary explains how well-intentioned efforts to manage pain in children might have unintentionally contributed to the opioid epidemic. The authors suggest that policy approaches may help address the problem at the system level.

Journal Article > Study

Incident and long-term opioid therapy among patients with psychiatric conditions and medications: a national study of commercial health care claims.

Quinn PD, Hur K, Chang Z, et al. Pain. 2017;158:140-148.

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.

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