From the, VA Eastern Colorado Health Care System, Veterans Health Administration, Aurora, CO.
National Academic Detailing Services, Veterans Health Administration, San Diego, CA.
Acad Emerg Med. 2020 Aug;27(8):734-741. doi: 10.1111/acem.13980. Epub 2020 May 12.
The Veterans Health Administration (VHA) Opioid Safety Initiative (OSI) was implemented in 2013 and was associated with a 25% relative decrease in the dispensing of opioids. Although emergency department (ED) providers play a role in the initiation and continuation of opioids, the incumbent OSI did not target EDs.
The goal of this feasibility study was to leverage the existing VHA OSI and test a novel ED-based quality improvement (QI) program to decrease opioid prescribing in multiple ED settings.
This was a quasi-experimental study of phased-in implementation of a QI ED-based OSI. The general setting for this pilot were four VHA EDs across the Veterans Integrated Services Network (VISN) region 19: Denver, Oklahoma City, Muskogee, and Salt Lake City. We developed and disseminated a dashboard to assess ED-specific prescribing rates and an ED-tailored toolkit to implement the program. Academic detailing pharmacists provided focused audits and feedback with the highest prescribing providers. We measured change in ED-provider prescribing rate of opioids for patients discharged from the ED, by provider and aggregated up to facility level, pre- and postimplementation.
Interrupted time-series analysis of provider-level data from the program implementation sites indicated a significant decrease in the trend for proportion of opioid prescriptions relative to the preintervention trend. The results of the analysis suggest that the intervention was associated with accelerating the rate at which ED provider prescribing rates decreased.
Due to the high volume of patients and the vital role the ED plays in patient treatment and hospital admissions, it is evident that the ED is an important site for QI programs as well as the implementation of opioid safety measures. Given the findings of this pilot, we believe that implementation of a national Veterans Affairs ED OSI implementation is feasible practice.
退伍军人健康管理局（VHA）阿片类药物安全倡议（OSI）于 2013 年实施，与阿片类药物配药减少 25%有关。尽管急诊科（ED）提供者在阿片类药物的开始和持续使用中发挥作用，但现行的 OSI 并没有针对 ED。
本可行性研究的目的是利用现有的 VHA OSI，并测试一种新的基于 ED 的质量改进（QI）计划，以减少多个 ED 环境中的阿片类药物处方。
这是一项关于基于 ED 的 QI OSI 分阶段实施的准实验研究。该试点的一般环境是退伍军人综合服务网络（VISN）区域 19 中的四个 VHA ED：丹佛、俄克拉荷马城、马斯克格罗夫和盐湖城。我们开发并分发了一个仪表板来评估特定 ED 的处方率和一个针对 ED 的工具包来实施该计划。学术详细药剂师为最高处方提供者提供了重点审计和反馈。我们通过提供者和汇总到设施级别，在实施前后测量从 ED 出院的 ED 提供者开出的阿片类药物的处方率变化。
来自计划实施地点的提供者水平数据的中断时间序列分析表明，与干预前趋势相比，阿片类药物处方比例的趋势明显下降。分析结果表明，干预措施与加快 ED 提供者处方率下降的速度有关。
由于患者数量众多，以及 ED 在患者治疗和住院方面的重要作用，很明显，ED 是 QI 计划以及阿片类药物安全措施实施的重要场所。鉴于本试验的结果，我们认为在全国退伍军人事务部 ED OSI 实施中实施是可行的做法。
