Implementing an Opioid Risk Reduction Program in the Acute Comprehensive Inpatient Rehabilitation Setting.

Autor:	Van SP; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD., Yao AL; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD., Tang T; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD., Kott M; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD., Noles A; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD., Dabai N; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD., Coslick A; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD., Rojhani S; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD., Sprankle LA; Department of Quality Improvement, Johns Hopkins Hospital, Baltimore, MD., Hoyer EH; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD; Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD. Electronic address: ehoyer1@jhmi.edu.
Jazyk:	angličtina
Zdroj:	Archives of physical medicine and rehabilitation [Arch Phys Med Rehabil] 2019 Aug; Vol. 100 (8), pp. 1391-1399. Date of Electronic Publication: 2019 May 21.
DOI:	10.1016/j.apmr.2019.04.011
Abstrakt:	Objective: To describe the implementation and evaluation of an interdisciplinary quality improvement (QI) project to increase prescription of take-home naloxone (THN) to reduce risks associated with opioids for patients admitted to an acute inpatient rehabilitation unit. Design: Prospective cohort quality improvement project. Setting: Eighteen-bed acute comprehensive inpatient rehabilitation (ACIR) unit at a large academic institution. Participants: Patients admitted to ACIR between December 2015-November 2016 (N=788). Interventions: An interdisciplinary QI model comprised of planning, education, implementation, and maintenance was used to implement a THN and opioid risk-reduction program involving provider and patient education. Analyses consisted of comparisons between baseline, early, and late phases of the project. Main Outcome Measures: (1) The proportion of eligible patients who received a prescription for naloxone upon discharge from ACIR; (2) the proportion of patients originally admitted to ACIR on opioids that were weaned off upon discharge. Results: The adjusted odds of eligible patients being discharged from ACIR with a naloxone prescription during the late QI period were 7 (95% confidence interval [CI]: 3-21) times higher than during the early QI period (late QI period: 43%, 95% CI: 25%-63%; early QI period: 10%, 95% CI: 3%-28%; P<.001). For patients admitted on opioids, the adjusted odds of being weaned off opioids during the late QI period were 10 (95% CI: 4-25) times higher than during baseline (late QI period: 29%, 95% CI: 17%-45%; baseline: 4%, 95% CI: 1%-10%; P<.001). Conclusions: Implementation of a THN and opioid risk reduction QI project in an inpatient rehabilitation setting led to significantly more eligible patients receiving naloxone and more patients weaned off schedule II opioids. (Copyright © 2019 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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