Firkus Danielle, Vyas Krina, Lovely Jenna K, Macon Elaine, Cunningham Julie
Department of Pharmacy, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, United States.
Department of Pharmacy, Ascension St. Vincent's Riverside, 1 Shircliff Way, Jacksonville, FL 32204, United States.
Surg Pract Sci. 2022 Nov 19;11:100147. doi: 10.1016/j.sipas.2022.100147. eCollection 2022 Dec.
In 2016, the CDC Guidelines for Prescribing Opioids in Chronic Pain recommended avoiding the co-prescribing of opioids and benzodiazepines when possible. This evaluation provides one institution's approach to improve safety for new, acute concurrent opioid and benzodiazepine prescribing.
Patients prescribed new, concurrent opioids and benzodiazepines upon discharge within one organization were identified. A chart review for the highest prescribing specialties was completed for a random sample of 100 patients to determine indications for prescribing, safety measures, and post discharge healthcare utilization.
Orthopedic surgery, the hospitalist service, neurosurgery, and general surgery had the highest concurrent prescribing rates. The most common indication for benzodiazepine prescribing was muscle spasms, but quantity variability existed across and within all four specialties. Of the subset of patients reviewed, patients were consistently not prescribed naloxone.
A prescribing guideline was implemented to provide educational tools, standardized benzodiazepine quantities, and naloxone co-prescribing recommendations for the indication of muscle spasms.
2016年,美国疾病控制与预防中心(CDC)的《慢性疼痛阿片类药物处方指南》建议尽可能避免同时开具阿片类药物和苯二氮䓬类药物。本评估提供了一个机构为提高新的急性同时开具阿片类药物和苯二氮䓬类药物的安全性所采取的方法。
确定在一个机构内出院时新开具同时使用阿片类药物和苯二氮䓬类药物的患者。对100名患者的随机样本进行了最高处方专科的病历审查,以确定处方指征、安全措施和出院后医疗保健利用情况。
骨科手术、住院医师服务、神经外科和普通外科的同时处方率最高。开具苯二氮䓬类药物最常见的指征是肌肉痉挛,但所有四个专科之间和内部都存在剂量差异。在审查的患者子集中,患者始终未开具纳洛酮。
实施了一项处方指南,以提供教育工具、标准化苯二氮䓬类药物剂量以及针对肌肉痉挛指征的纳洛酮联合处方建议。