Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, and Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD.
Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD.
Am J Health Syst Pharm. 2020 Apr 1;77(8):636-643. doi: 10.1093/ajhp/zxaa027.
The opioid epidemic continues to result in significant morbidity and mortality even within hospitals where opioids are the second most common cause of adverse events. Opioid stewardship represents one model for hospitals to promote safe and rational prescribing of opioids to mitigate preventable adverse events in alliance with new Joint Commission standards. The purpose of this study was to identify the prevalence of current hospital practices to improve opioid use.
A cross-sectional survey of hospital best practices for opioid use was electronically distributed via electronic listservs in March 2018 to examine the presence of an opioid stewardship program and related practices, including formulary restrictions, specialist involvement for high-risk patients, types of risk factors screened, and educational activities.
Among 133 included hospitals, 23% reported a stewardship program and 14% reported a prospective screening process to identify patients at high risk of opioid-related adverse events (ORAEs). Among those with a prospective screening process, there was variability in ORAE risk factor screening. Formulary restrictions were dependent on specific opioids and formulations. Patient-controlled analgesia was restricted at 45% of hospitals. Most hospitals reported having a pain management service (90%) and a palliative care service providing pain management (67%).
The absence of opioid stewardship and prospectively screening ORAEs represents a gap in current practice at surveyed hospitals. Hospitals have an opportunity to implement and refine best practices such as access to pain management specialists, use of formulary restrictions, and retrospective and prospective monitoring of adverse events to improve opioid use.
即使在医院中，阿片类药物也仍是导致不良事件的第二大常见原因，因此阿片类药物泛滥问题仍会导致严重的发病率和死亡率。阿片类药物管理代表了一种模式，医院可以通过这种模式与新的联合委员会标准合作，促进安全合理地开具阿片类药物处方，以减轻可预防的不良事件。本研究的目的是确定当前改善阿片类药物使用的医院实践的流行情况。
2018 年 3 月，通过电子名录服务以电子方式分发了一项关于医院阿片类药物使用最佳实践的横断面调查，以检查是否存在阿片类药物管理计划和相关实践，包括处方限制、高危患者的专家参与、筛选的风险因素类型以及教育活动。
在纳入的 133 家医院中，23%的医院报告有管理计划，14%的医院报告有前瞻性筛选程序，以确定有阿片类药物相关不良事件（ORAEs）风险的患者。在进行前瞻性筛选的医院中，ORAEs 风险因素的筛选存在差异。处方限制取决于特定的阿片类药物和制剂。45%的医院限制使用患者自控镇痛。大多数医院报告有疼痛管理服务（90%）和提供疼痛管理的姑息治疗服务（67%）。
在调查的医院中，缺乏阿片类药物管理和前瞻性 ORAEs 筛查代表了当前实践中的一个差距。医院有机会实施和完善最佳实践，例如获得疼痛管理专家的帮助、使用处方限制以及对不良事件进行回顾性和前瞻性监测，以改善阿片类药物的使用。
