Tirondola, Michele. An alternative to opioids guideline for acute pain management in the emergency department. Retrieved from https://doi.org/doi:10.7282/t3-pgmh-4h64
DescriptionPurpose: Many emergency departments contribute to the current opioid epidemic plaguing this country. Opioid overprescribing leads to increased healthcare costs, increased emergency department utilization, and increased morbidity and mortality. Methods to decreased opioid prescribing rates include prescribing guidelines, protocols, and education.
Methodology: An “Alternative to Opioids” guideline was created for use within a community emergency department, with goals of decreasing overall opioid prescribing rates. The implementation included one-on-one provider educational sessions regarding the use of the guideline and the background and significance surrounding its creation. Chart reviews were conducted pre- and post-implementation to review opioid prescribing rates and patterns.
Results: Chart reviews included 357 participants pre-implementation and 227 participants post-implementation. There was a decrease in total opioid prescribing within the by 1,243 mg (measured in morphine milligram equivalents) and at time of discharge by 226 mg (measured in morphine milligram equivalents) from pre-intervention to post-intervention. The mean morphine milligram equivalents (MME) prescribed within the department increased by 1.3 mg and at time of discharge by 1.3 mg. Two Mann Whitney U tests indicated that the opioid prescribing rates within the department (Z = -1.015, r = 0.310) and at time of discharge (Z = -1.107, r = 0.268) were not significantly different for the pre-implementation group compared to the post-implementation group.
Discussion: There was no statistically significant change in opioid prescribing rates from pre-implementation to post-implementation after the launch of an Alternative to Opioids guideline. There was an overall decrease in total opioids prescribed from pre-implementation to post-implementation, though conclusions on whether the ALTO was cause behind this decrease is undetermined. However, the data collection yielded interesting results on opioid prescribing patterns which can be used for future. Revisions in the educational portion as well as incorporation of the guideline into the electronic medical record could help facilitate further improvement in the opioid prescribing rates in this emergency department.