Abstract
IntroductionWe aimed to evaluate the patterns of analgesic prescribing for emergency department (ED) patients suffering from pain of renal colic before, during, and after implementation of an opioid reduction initiative. We hypothesized that this initiative based on the concept of channels/enzymes/receptors-targeted analgesia would result in overall decrease in opioid utilization in the ED and at discharge.MethodsWe performed a retrospective analysis of ED electronic medical record of patients presenting with renal colic who received analgesics in the ED and at discharge over a five-year period. Patients were divided into three groups based on the following periods: 2012–2014 (pre-implementation phase); 2014–2015 (implementation phase); and 2015–2017 (post-implementation).ResultsA total of 4,490 patients presented to the ED with renal colic over a five-year study period. Analgesics were administered to 3,793 ED patients of whom 1,704 received opioids and 2,675 received non-opioid analgesics. A total of 3,533 ED patients received a prescription for analgesic(s) upon discharge from the ED: 2,692 patients received opioids, and 2,228 received non-opioids. We observed a 12.7% overall decrease from the pre-implementation to post-implementation time period in opioid prescribing in the ED and a 25.5% decrease in opioid prescribing at discharge, which translated into 432 and 768 fewer patients receiving opioids, respectively.ConclusionImplementation of an opioid-reduction initiative based on patient-specific, pain syndrome-targeted opioid alternative protocols resulted in a reduction in opioid administration in the ED by 12.7% and at prescriptions at discharge by 25.5%. Adoption of similar ED initiatives nationwide has the potential to foster effective non-opioid analgesic practices for ED patients presenting with renal colic and to reduce physicians’ reliance on administering and prescribing opioids.
Highlights
We aimed to evaluate the patterns of analgesic prescribing for emergency department (ED) patients suffering from pain of renal colic before, during, and after implementation of an opioid reduction initiative
Implementation of an opioid-reduction initiative based on patient-specific, pain syndrometargeted opioid alternative protocols resulted in a reduction in opioid administration in the ED by 12.7% and at prescriptions at discharge by 25.5%
Adoption of similar ED initiatives nationwide has the potential to foster effective non-opioid analgesic practices for ED patients presenting with renal colic and to reduce physicians’ reliance on administering and prescribing opioids. [West J Emerg Med. 2018;19(6)1028–1035.]
Summary
We aimed to evaluate the patterns of analgesic prescribing for emergency department (ED) patients suffering from pain of renal colic before, during, and after implementation of an opioid reduction initiative. We hypothesized that this initiative based on the concept of channels/enzymes/receptorstargeted analgesia would result in overall decrease in opioid utilization in the ED and at discharge. The uncontrolled prescribing of opioid analgesics in the 1990s resulted in collateral damage in the form of abuse, diversion, misuse, and development of opioid use disorder.[1,2,3,4,5] Between 1999 and 2010, the rate of opioid prescribing increased by Analgesic Administration for Patients with Renal Colic in the ED. 700%.1,2 In 2012 alone, healthcare providers wrote 259 million opioid prescriptions, an amount sufficient to supply every American adult with a bottle of opioid pills.[3,4,5] In 2014, 10.3 million persons reported using prescription opioids nonmedically.[2,3] More importantly, this massive escalation of prescription opioid use led to a 200% increase in mortality related to unintentional opioid overdose between 2000 and 2014.6-13 between 2013 and 2014 alone, opioid-related deaths in the U.S increased 14%, from 7.9 to 9.0 per 100,000 population.[6, 7] More recently, about 66% of approximately 64,000 drug overdose deaths in 2016 involved an opioid, which translates to an average of 115 Americans dying every day from an opioid overdose.[8]
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