From the Department of Pharmacy Services, University of Rochester Medical Center, Rochester, NY.
J Patient Saf. 2021 Dec 1;17(8):e1585-e1588. doi: 10.1097/PTS.0000000000000735.
Opioids are high-risk medications in the inpatient setting because of their potential for significant patient harm. The primary objective was to identify risk factors that predispose inpatients to develop opioid-related adverse drug events (ORADE) requiring the use of naloxone.
In a retrospective case-control study, patients were included according to the following criteria: 18 years or older, 1 administered opioid doses or more, and admitted for 24 hours or more. Patients were excluded if they had a prehospital drug overdose, other indications for naloxone use, or were admitted to an intensive care unit, psychiatric medical unit, or in the emergency department. Patients were classified as cases if naloxone was administered and a selection of controls were frequency matched 2:1 based on medical or surgical status. A logistic regression model was used to evaluate for risk factors for ORADE.
A total of 275 cases and 592 control patients were included into the final analysis. Variables that were associated with greater odds of naloxone administration included age of 65 years or older, female, length of stay, pulmonary diagnoses, use of gabapentinoids, and patient-controlled analgesia use. Antihistamines, continuous infusion, and intermittent nurse administered intravenous bolus routes had a negative association with naloxone use.
Several risk factors were found to be associated with ORADE supporting many of the previously described risk factors, and the discovery of potential new ones, such as gabapentinoid use. Health care providers should consider the risk factors for hospitalized patients receiving opioids who may warrant lower doses, additional monitoring, or alternative agents.
在住院环境中，由于阿片类药物可能对患者造成严重伤害，因此它们是高风险药物。主要目的是确定使住院患者易发生需要使用纳洛酮的阿片类药物相关不良药物事件（ORADE）的风险因素。
在回顾性病例对照研究中，根据以下标准纳入患者：年龄在 18 岁或以上，接受 1 次或更多次阿片类药物剂量，住院时间为 24 小时或更长时间。如果患者有院前药物过量、纳洛酮使用的其他指征，或入住重症监护病房、精神科医疗病房或急诊科，则将其排除在外。如果给予纳洛酮且选择了一定数量的对照，则根据医疗或手术状况以 2:1 的频率匹配，则将患者分类为病例。使用逻辑回归模型评估 ORADE 的风险因素。
共有 275 例病例和 592 例对照患者被纳入最终分析。与纳洛酮给药几率较高相关的变量包括 65 岁或以上的年龄、女性、住院时间、肺部诊断、加巴喷丁类药物的使用和患者自控镇痛的使用。抗组胺药、持续输注和间歇性护士给予静脉推注途径与纳洛酮的使用呈负相关。
发现了一些与 ORADE 相关的风险因素，这些因素支持许多先前描述的风险因素，以及发现了一些潜在的新风险因素，如加巴喷丁类药物的使用。医疗保健提供者应考虑接受阿片类药物治疗的住院患者的风险因素，这些患者可能需要较低的剂量、额外的监测或替代药物。
