Continuation of Opioid Therapy at Transitions of Care in Critically Ill Patients
| Autor: | Leah S. Millstein, Mojdeh S. Heavner, Asha L. Tata, Mangla Gulati, Danya M. Qato, Emily J Witcraft, Jeffrey P. Gonzales, Ian Watt, Siu Yan Amy Yeung, Hyunuk Seung |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Critical Illness Critical Care and Intensive Care Medicine 01 natural sciences law.invention 03 medical and health sciences Continuation 0302 clinical medicine law medicine Humans 030212 general & internal medicine Practice Patterns Physicians' 0101 mathematics Intensive care medicine Retrospective Studies Critically ill business.industry 010102 general mathematics Intensive care unit Analgesics Opioid Intensive Care Units Opioid business medicine.drug |
| Zdroj: | Journal of Intensive Care Medicine. 36:879-884 |
| ISSN: | 1525-1489 0885-0666 |
| Popis: | Purpose: Opioids are one of the high-risk medication classes that are administered to critically ill patients during their intensive care unit (ICU) stay. However, little attention has been given to inpatient opioid prescribing practices, especially in critically ill patients. The purpose of our study was to characterize opioid prescribing practices across 2 transitions of care during an inpatient hospital stay: medical ICU (MICU)/intermediate care unit (IMC) to floor and floor to hospital discharge and identify potential patient-specific factors that impact opioid continuation. Methods: This is a retrospective cohort study evaluating opioid-naive adult patients with new opioid therapy initiated in MICU/IMC at a tertiary care academic medical center from December 1, 2016, to November 30, 2017. Opioid continuation rate was assessed twice: transition 1 (MICU/IMC to floor) and transition 2 (floor to hospital discharge). Results: In total, 112 opioid-naive patients with initial opioid administration in the MICU/IMC were included. Opioid therapy was continued in 56.1% (37/66) at transition 1 and 56.8% of patients (21/37) at transition 2. Patients with opioids continued at transition 1 had a longer hospital length of stay compared to those not continued on opioids, 22 (interquartile range [IQR] 11-36) vs 8 (IQR 6-14; P = .0004). Among the patients continued on opioids at hospital discharge, intubation during hospital stay and cumulative opioid dosage were greater than those not continued on opioids (17 [80.9%] vs 7 [43.8%], P = .019; and 3482 mcg [IQR 1690-9530] vs 732.5 mcg [IQR 187.5-1360.9], P = .0018, respectively). Conclusions: Opioid-naive patients receiving opioid therapy in the MICU/IMC had a continuation rate of >56% during transitions of care, including hospital discharge. Factors that contributed to the continuation of opioids at transitions of care included longer hospital length of stay, intubation, and cumulative hospital opioid dosage. These findings may help to provide health systems with guidance on targeted opioid stewardship programs. |
| Databáze: | OpenAIRE |
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