The changing use of intravenous opioids in an emergency department

Mark E Sutter, Garen J Wintemute, Samuel O Clarke, Bailey M. Roche, James Chenoweth, Rory Gutierrez, Timothy E Albertson

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Introduction: Government agencies are increasingly emphasizing opioid safety in hospitals. In 2012, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) started a sentinel event program, the "Safe Use of Opioids in Hospitals." We sought to determine if opioid use patterns in our emergency department (ED) changed from 2011, before the program began, to 2013, after start of the program. Methods: This was a retrospective study of all adult ED patients who received an intravenous opioid and had a serum creatinine measured. We recorded opioids used, dose prescribed, and serum creatinine. As an index of the safety of opioids, uses of naloxone after administration of an opioid was recorded. Results: Morphine is still the most commonly used opioid by doses given, but its percentage of opioids used decreased from 68.9% in 2011 to 52.8% in 2013. During the same period, use of hydromorphone increased from 27.5% to 42.9%, while the use of fentanyl changed little (3.6% to 4.3%). Naloxone administration was rare after an opioid had been given. Opioids were not dosed in an equipotent manner. Conclusion: The use of hydromorphone in our ED increased by 56% (absolute increase of 15.4%), while the use of morphine decreased by 30.5% (absolute decrease 16.1%) of total opioid use from 2011 to 2013. The JCAHO program likely was at least indirectly responsible for this change in relative dosing of the opioids. Based on frequency of naloxone administered after administration of an opioid, the use of opioids was safe.

Original languageEnglish (US)
Pages (from-to)1079-1083
Number of pages5
JournalWestern Journal of Emergency Medicine
Volume16
Issue number7
DOIs
StatePublished - 2015

Fingerprint

Opioid Analgesics
Hospital Emergency Service
Naloxone
Hydromorphone
Joint Commission on Accreditation of Healthcare Organizations
Morphine
Creatinine
Government Agencies
Safety
Fentanyl
Serum
Retrospective Studies

Keywords

  • Medication safety
  • Opioids

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

The changing use of intravenous opioids in an emergency department. / Sutter, Mark E; Wintemute, Garen J; Clarke, Samuel O; Roche, Bailey M.; Chenoweth, James; Gutierrez, Rory; Albertson, Timothy E.

In: Western Journal of Emergency Medicine, Vol. 16, No. 7, 2015, p. 1079-1083.

Research output: Contribution to journalArticle

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abstract = "Introduction: Government agencies are increasingly emphasizing opioid safety in hospitals. In 2012, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) started a sentinel event program, the {"}Safe Use of Opioids in Hospitals.{"} We sought to determine if opioid use patterns in our emergency department (ED) changed from 2011, before the program began, to 2013, after start of the program. Methods: This was a retrospective study of all adult ED patients who received an intravenous opioid and had a serum creatinine measured. We recorded opioids used, dose prescribed, and serum creatinine. As an index of the safety of opioids, uses of naloxone after administration of an opioid was recorded. Results: Morphine is still the most commonly used opioid by doses given, but its percentage of opioids used decreased from 68.9{\%} in 2011 to 52.8{\%} in 2013. During the same period, use of hydromorphone increased from 27.5{\%} to 42.9{\%}, while the use of fentanyl changed little (3.6{\%} to 4.3{\%}). Naloxone administration was rare after an opioid had been given. Opioids were not dosed in an equipotent manner. Conclusion: The use of hydromorphone in our ED increased by 56{\%} (absolute increase of 15.4{\%}), while the use of morphine decreased by 30.5{\%} (absolute decrease 16.1{\%}) of total opioid use from 2011 to 2013. The JCAHO program likely was at least indirectly responsible for this change in relative dosing of the opioids. Based on frequency of naloxone administered after administration of an opioid, the use of opioids was safe.",
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AU - Albertson, Timothy E

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