Opioid prescribing in the emergency department of a tertiary hospital: A retrospective audit of hospital discharge data.

Abstract

EDs are a common source of prescription opioids on discharge. We explored opioid prescribing practices in an ED at a tertiary hospital in Victoria, Australia. A retrospective audit over a 6 month period of patients discharged from the ED to the community with the maximum allowable quantities of prescription opioids. There was a total of 3301 patient-episodes discharged with a prescription from the ED. Of these, 766 (23.2%, 95% confidence interval [CI] 21.8-24.6) were prescribed opioids, with over half discharged with the maximum allowable quantities of prescription opioids. Immediate-release opioids were prescribed in 362 (85.8%, 95% CI 82.5-89.1) patient-episodes, a combination of immediate-release and slow-release preparations were prescribed in 29 (6.9%, 95% CI 4.5-9.3) and 31 (7.3%, 95% CI 4.8-9.8) were prescribed as slow-release opioids alone. Co-prescription of other analgesia with opioids occurred in 152 (36.0%, 95% CI 31.4-40.6) patient-episodes. Possible drug interactions between opioids and other medications were noted in 117 (27.7%, 95% CI 23.4-32.0) patient-episodes. Discharge summaries were prepared for 360 (85.3%, 95% CI 81.9-88.7) patient-episodes, but only 171 (40.5%, 95% CI 35.8-45.2) included a plan to address the opioids, be that an opioid-weaning regimen, analgesia review or referral to a pain specialist on discharge. Opioid prescribing was common in this ED, with almost one-quarter of discharge prescriptions being for a prescription opioid. This audit highlights potential areas for practice improvement including review of the quantity of opioid tablets prescribed as well as an opioid plan on discharge from the ED.