University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, United States..
Veterans Affairs Eastern Colorado Health Care System, 1055 Clermont Street, Denver, CO 80220, United States.
Addict Behav. 2018 Nov;86:40-43. doi: 10.1016/j.addbeh.2018.04.018. Epub 2018 Apr 27.
The Veterans Affairs (VA) Eastern Colorado Health Care System implemented an Opioid Safety Initiative (OSI); this included multidisciplinary chart reviews of patients with chronic, non-malignant pain on high-dose opioid therapy to provide safety recommendations to prescribers through the electronic medical record. Our study objective was to evaluate the impact of these documented recommendations. Outcomes included change in total daily opioid dose, concurrent prescribing of opioids and benzodiazepines, adherence to local VA/Veterans Integrated Service Network (VISN) policy, and monitoring practices.
This retrospective chart review of patients prescribed ≥200 mg of morphine equivalent daily dose (MEDD) collected data from OSI chart reviews conducted between January 1, 2015 and March 31, 2015. Outcomes were assessed during the 12 months following initial review. Primary outcomes included: opioid dose reduction, discontinuation of concurrent benzodiazepines, and adherence to VA/VISN policy, including documentation of signed informed Consent for Long-Term Opioid Therapy for Pain, biannual urine drug screens (UDS), and follow-up every six months with primary opioid prescriber.
Of 147 patients meeting inclusion criteria, 50 patients (34%) reduced opioid dose with the baseline median MEDD decreasing from 315 mg to 278 mg. Of the 48 patients prescribed benzodiazepines and opioids, 10 patients discontinued benzodiazepines (21%). Completion of informed consents increased from 31% to 48%, biannual UDS increased from 44% to 61%, and follow-up with opioid prescriber was unchanged.
After completion of OSI chart reviews, reduction in opioid dose and concurrent prescribing of benzodiazepines was observed. VA/VISN policy and monitoring adherence also showed improvement.
退伍军人事务部（VA）东科罗拉多医疗保健系统实施了阿片类药物安全倡议（OSI）；这包括对接受高剂量阿片类药物治疗的慢性非恶性疼痛患者进行多学科图表审查，通过电子病历向开处方者提供安全建议。我们的研究目的是评估这些有记录的建议的影响。结果包括总日阿片类药物剂量的变化、同时开具阿片类药物和苯二氮䓬类药物、遵守当地退伍军人事务部/退伍军人综合服务网络（VISN）政策和监测做法。
这项回顾性图表审查了处方剂量≥200mg 吗啡当量日剂量（MEDD）的患者，数据来自于 2015 年 1 月 1 日至 2015 年 3 月 31 日期间进行的 OSI 图表审查。在最初审查后的 12 个月内评估结果。主要结果包括：阿片类药物剂量减少、停止同时开具苯二氮䓬类药物以及遵守退伍军人事务部/退伍军人综合服务网络政策，包括签署长期阿片类药物治疗疼痛知情同意书、每六个月进行一次尿液药物筛查（UDS）以及每六个月与主要阿片类药物开处方者进行一次随访。
在符合纳入标准的 147 名患者中，有 50 名患者（34%）减少了阿片类药物剂量，基线中位数 MEDD 从 315mg 降至 278mg。在同时开具苯二氮䓬类药物和阿片类药物的 48 名患者中，有 10 名患者停止了苯二氮䓬类药物（21%）。知情同意书的完成率从 31%增加到 48%，每六个月进行一次 UDS 的比例从 44%增加到 61%，而与阿片类药物开处方者的随访没有变化。
完成 OSI 图表审查后，观察到阿片类药物剂量减少和同时开具苯二氮䓬类药物的情况。退伍军人事务部/退伍军人综合服务网络政策和监测依从性也有所改善。
