Inpatient protocol reduces use of IV opioids by 84%

  • JAMA Intern Med

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • An inpatient opioid prescribing protocol that prioritized oral and subcutaneous opioid administration over intravenous (IV) administration reduced the use of IV opioids by 84% and the overall use of oral or parenteral opioids by 23%.

Why this matters

  • Compared with orally administered opioids, IV-administered opioids increase the risk for adverse events, including euphoria, nausea, and hypotension.

Study design

  • Pilot study of 414 attending physicians, nurse practitioners, and physician assistants (intervention group, n=127; control, n=287) who prescribed opioids.
  • Reduction in IV opioid doses administered per patient-day and total parenteral and overall opioid doses per patient-day and exposure were assessed.
  • Funding: None disclosed.

Key results

  • Mean age of the participants was 57.6 years; the control period included 4500 patient-days and intervention period included 2459 patient-days.
  • During the intervention period, significant reduction observed in IV opioid doses (84%; P<.001 and combined doses of parenteral opioids administered either intravenously or subcutaneously p>
  • In the intervention group, mean daily parenteral opioid exposure decreased by 49% and rate of parenteral opioid administration decreased by 57% (P<.001>
  • Significant reduction in opioid dose administered by oral or parenteral route (23%; P=.02) and in mean daily overall opioid exposure (31%).

Limitations

  • Single-center study.

Coauthored with Anand Ramanathan, PharmD

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