目标:在我们的急诊科(ED),阿片类药物处方指南于2016年9月实施。根据密歇根急诊医师学院的集体努力和倡导,采用并修订了阿片类药物处方指南,以进行ED领导的阿片类药物管理。我们在研究前后进行了回顾性研究,以确定阿片类药物处方指南是否会改变郊区学术ED中每位患者静脉注射阿片类药物的使用以及每位患者的吗啡当量单位(MEU)。
方法:在三级护理1级创伤中心进行了一项回顾性观察性研究,每年的ED量约为130,000次。所有静脉注射芬太尼,吗啡,我们对2015年1月1日至2017年12月31日期间的成人患者和氢吗啡酮进行了列表.使用3个月(2016年8月至2016年10月)的洗脱期。使用泊松和普通线性回归分析来评估在采用指南之前和之后订购的静脉阿片类药物数量的任何差异。在我们的阿片类药物处方指南中,还提供了ED中口服阿片类药物订单和口服阿片类药物处方的指导,尽管这些要素不包括在本次调查中。
结果:最终分析中包括总共108,327个静脉阿片类药物订单。在采用阿片类药物处方指南后,订购的静脉注射阿片类药物的预期数量下降了3.1%(eβ,0.969;95%置信区间[CI],0.779-1.209),每月额外减少0.1%(eβ,0.999;95%CI,0.990-1.010)。在通过阿片类药物处方指南后,平均MEU下降0.3mg(95%CI,-0.47至-0.13),每月减少0.01mg(95%CI,-0.02至-0.004)。
结论:在采用阿片类药物处方指南后,我们的分析表明,阿片类药物处方指南与ED中MEU排序的临床微小但有统计学意义的变化相关.我们无法确定这是否代表阿片类药物使用减少的持续趋势或与阿片类药物处方指南相关。
OBJECTIVE: At our emergency department (ED), opioid prescribing guidelines were implemented in September 2016. The opioid prescribing guidelines were adopted and revised from collective efforts and advocacy of the Michigan College of Emergency Physicians for ED-led opioid stewardship. We performed a retrospective before and after study to determine if opioid prescribing guidelines would change the use of
intravenous opioids per patient and the morphine equivalent units (MEU) per patient in a suburban academic ED.
METHODS: A retrospective observational study was conducted at a tertiary care level 1 trauma center with an annual ED volume of ≈ 130,000 visits. All
intravenous orders of fentanyl, morphine, and hydromorphone for adult patients from January 1, 2015, through December 31, 2017, were tabulated. A 3-month (August 2016-October 2016) washout period was used. Poisson and ordinary linear regression analyses were employed to evaluate any difference in number of
intravenous opioids ordered before and after adoption of the guidelines. Within our opioid prescribing guidelines was also guidance for oral opioid orders within the ED and oral opioid prescriptions for discharge, although these elements were not included in this investigation.
RESULTS: A total of 108,327
intravenous opioid orders were included in the final analysis. After adoption of the opioid prescribing
guidelines, the expected number of
intravenous opioids ordered dropped by 3.1% (eβ, 0.969; 95% confidence interval [CI], 0.779-1.209), and there was an additional decrease of 0.1% per month (eβ, 0.999; 95% CI, 0.990-1.010). After the adoption of opioid prescribing guidelines, the average MEU dropped by 0.3 mg (95% CI, -0.47 to -0.13), and there was decrease of 0.01 mg per month (95% CI, -0.02 to -0.004).
CONCLUSIONS: After the adoption of opioid prescribing guidelines, our analysis suggests that opioid prescribing guidelines are associated with clinically small but statistically significant changes in MEU ordered in ED. We cannot determine if this represented a continued trend of decreased opioid use or associated with the opioid prescribing guidelines.