The University of Ottawa, Ottawa, ON, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
CJEM. 2022 Sep;24(6):641-649. doi: 10.1007/s43678-022-00352-7. Epub 2022 Aug 15.
Currently, there are no Canadian guidelines for discharge instruction to be given to patients receiving an opioid prescription in the ED. This likely contributes to inadequate discharge instructions for these potentially dangerous medications. The principal goal of this study was to develop an interdisciplinary Canadian consensus regarding important concepts to be included in written opioid discharge instructions within the ED setting.
We conducted a modified Delphi study between May and August 2021. The national multidisciplinary panel consisted of 23 healthcare professionals and one patient partner. The survey consisted of 19 initial concepts developed after a review of the literature and a meeting with local experts. The panel added four new concepts after the first survey round. Three rounds of online surveys were distributed in total. Panel consensus was defined a priori as a disagreement index score less than 1, in accordance with the RAND/UCLA Appropriateness Method.
We achieved a 100% response rate in round one and a 96% response rate in rounds two and three of our Delphi study. There was group consensus (disagreement index = 0.66, median importance = 9) that all patients receiving opioid prescriptions from the ED should receive written discharge instructions. The interdisciplinary panel arrived at a consensus on 21/23 concepts for ED opioid discharge instructions. The concepts with the highest level of agreement were related to minimizing the use of the prescribed opioid medication and opioid use safety (mixing with drugs/alcohol, storage, and impairment).
This Delphi study with a national, multidisciplinary panel achieved consensus on 21 concepts that should be included in written discharge instructions to patients receiving an opioid prescription upon discharge from the ED.
目前，加拿大尚无关于在急诊室向接受阿片类药物处方的患者提供出院指导的指南。这可能导致这些潜在危险药物的出院指导不足。本研究的主要目标是就书面阿片类药物出院指导中应包含的重要概念达成一项跨学科的加拿大共识。
我们于 2021 年 5 月至 8 月期间进行了一项改良 Delphi 研究。国家多学科小组由 23 名医疗保健专业人员和 1 名患者伙伴组成。该调查包括 19 个初始概念，这些概念是在文献回顾和与当地专家会议后提出的。小组在第一轮调查后又增加了 4 个新概念。总共进行了三轮在线调查。小组共识预先定义为根据 RAND/UCLA 适宜性方法，分歧指数评分小于 1。
我们在第一轮调查中达到了 100%的回复率，在第二轮和第三轮调查中达到了 96%的回复率。所有从急诊室接受阿片类药物处方的患者都应收到书面出院指导，这一点得到了小组的一致同意（分歧指数=0.66，中位数重要性=9）。跨学科小组就 23 个急诊室阿片类药物出院指导的概念达成了共识。具有最高一致性的概念与最大限度减少规定阿片类药物的使用和阿片类药物使用安全（与药物/酒精混合、储存和损伤）有关。
这项具有国家多学科小组的 Delphi 研究就应包含在从急诊室开出阿片类药物处方的患者的书面出院指导中的 21 个概念达成了共识。
