Witcraft Emily J, Gonzales Jeffrey P, Seung Hyunuk, Watt Ian, Tata Asha L, Yeung Siu Yan Amy, Heavner Mojdeh S, Qato Danya M, Gulati Mangla S, Millstein Leah S
Department of Pharmacy, 2334University of North Carolina Medical Center, Chapel Hill, NC, USA.
Baltimore, MD, USA.
J Intensive Care Med. 2021 Aug;36(8):879-884. doi: 10.1177/0885066620933798. Epub 2020 Jun 18.
Opioids are one of the high-risk medication classes that are administered to critically ill patients during their intensive care unit (ICU) stay. However, little attention has been given to inpatient opioid prescribing practices, especially in critically ill patients. The purpose of our study was to characterize opioid prescribing practices across 2 transitions of care during an inpatient hospital stay: medical ICU (MICU)/intermediate care unit (IMC) to floor and floor to hospital discharge and identify potential patient-specific factors that impact opioid continuation.
This is a retrospective cohort study evaluating opioid-naive adult patients with new opioid therapy initiated in MICU/IMC at a tertiary care academic medical center from December 1, 2016, to November 30, 2017. Opioid continuation rate was assessed twice: transition 1 (MICU/IMC to floor) and transition 2 (floor to hospital discharge).
In total, 112 opioid-naive patients with initial opioid administration in the MICU/IMC were included. Opioid therapy was continued in 56.1% (37/66) at transition 1 and 56.8% of patients (21/37) at transition 2. Patients with opioids continued at transition 1 had a longer hospital length of stay compared to those not continued on opioids, 22 (interquartile range [IQR] 11-36) vs 8 (IQR 6-14; = .0004). Among the patients continued on opioids at hospital discharge, intubation during hospital stay and cumulative opioid dosage were greater than those not continued on opioids (17 [80.9%] vs 7 [43.8%], = .019; and 3482 mcg [IQR 1690-9530] vs 732.5 mcg [IQR 187.5-1360.9], = .0018, respectively).
Opioid-naive patients receiving opioid therapy in the MICU/IMC had a continuation rate of >56% during transitions of care, including hospital discharge. Factors that contributed to the continuation of opioids at transitions of care included longer hospital length of stay, intubation, and cumulative hospital opioid dosage. These findings may help to provide health systems with guidance on targeted opioid stewardship programs.
阿片类药物是重症监护病房（ICU）重症患者使用的高风险药物类别之一。然而，住院患者阿片类药物的处方行为很少受到关注，尤其是在重症患者中。我们研究的目的是描述住院期间两个护理过渡阶段的阿片类药物处方行为：从医学重症监护病房（MICU）/中级护理病房（IMC）到普通病房以及从普通病房到出院，并确定影响阿片类药物继续使用的潜在患者特异性因素。
这是一项回顾性队列研究，评估2016年12月1日至2017年11月30日在一家三级医疗学术中心的MICU/IMC开始接受新阿片类药物治疗的未使用过阿片类药物的成年患者。阿片类药物继续使用率评估了两次：过渡阶段1（从MICU/IMC到普通病房）和过渡阶段2（从普通病房到出院）。
总共纳入了112例在MICU/IMC首次接受阿片类药物治疗的未使用过阿片类药物的患者。在过渡阶段1，56.1%（37/66）的患者继续使用阿片类药物治疗；在过渡阶段2，56.8%（21/37）的患者继续使用。与未继续使用阿片类药物的患者相比，在过渡阶段1继续使用阿片类药物的患者住院时间更长，分别为22天（四分位间距[IQR]为11 - 36天）和8天（IQR为6 - 14天；P = 0.0004）。在出院时继续使用阿片类药物的患者中，住院期间插管情况和累积阿片类药物剂量均高于未继续使用阿片类药物的患者（分别为17例[80.9%]对7例[43.8%]，P = 0.019；以及3482微克[IQR为1690 - 9530微克]对732.5微克[IQR为187.5 - 1360.9微克]，P = 0.0018）。
在MICU/IMC接受阿片类药物治疗的未使用过阿片类药物的患者在护理过渡阶段（包括出院）的继续使用率>56%。在护理过渡阶段导致阿片类药物继续使用的因素包括住院时间更长、插管以及住院期间累积阿片类药物剂量。这些发现可能有助于为卫生系统提供有关针对性阿片类药物管理计划的指导。
