Stanley Beata, Norman Amanda F, Collins Lisa J, Zographos George A, Lloyd-Jones David M, Bonomo Anthony, Bonomo Yvonne A
Department of Addiction Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
ANZ J Surg. 2018 Nov;88(11):1187-1192. doi: 10.1111/ans.14873. Epub 2018 Oct 10.
To understand patterns of opioid prescribing on discharge in the orthopaedic and neurosurgical wards of a tertiary metropolitan hospital.
A retrospective audit of medical records and discharge summaries for all orthopaedic and neurosurgical patients admitted for at least 2 days on two surgical wards over a 6-month period between 1 January and 30 June 2017.
A combined total of 355 patients (281 orthopaedic and 74 neurosurgical patients) were included in the audit. Approximately 82% were discharged on opioids. Of patients discharged on opioids, 71.4% of the orthopaedic group and 73.8% of the neurosurgical group were discharged on combinations of two or more opioids (immediate release together with slow release). Around 65% of the sample discharged on opioids was opioid naïve on admission. About 32.5% of the orthopaedic patients and 68.9% of the neurosurgical patients were discharged on a combination of opioid and other pharmacotherapy that could potentiate the central nervous system depressant effect of the opioids. Only 6.9% of orthopaedic patients and 11.5% of the neurosurgical patients had discharge summaries that included any reference to opioid management after discharge.
Orthopaedic and neurosurgical units had high opioid prescribing rates on discharge from hospital. This highlights the need for clear communication of the intended medication management plan post-discharge in order to minimize inappropriate and ongoing use of opioids post-surgery.
了解一家大型都市三级医院骨科和神经外科病房出院时阿片类药物的处方模式。
对2017年1月1日至6月30日期间在两个外科病房住院至少2天的所有骨科和神经外科患者的病历及出院小结进行回顾性审计。
共有355名患者（281名骨科患者和74名神经外科患者）纳入审计。约82%的患者出院时使用了阿片类药物。在出院时使用阿片类药物的患者中，骨科组71.4%和神经外科组73.8%出院时使用了两种或更多阿片类药物的组合（即速释剂与缓释剂联用）。出院时使用阿片类药物的样本中，约65%的患者入院时未使用过阿片类药物。约32.5%的骨科患者和68.9%的神经外科患者出院时联用了阿片类药物和其他可能增强阿片类药物中枢神经系统抑制作用的药物治疗。只有6.9%的骨科患者和11.5%的神经外科患者的出院小结中提及了出院后的阿片类药物管理。
骨科和神经外科病房患者出院时阿片类药物的处方率较高。这凸显了出院后明确传达预期药物管理计划的必要性，以尽量减少术后阿片类药物的不当和持续使用。
