The impact of an innovative pharmacist-led inpatient opioid de-escalation intervention in post-operative orthopedic patients.
J Opioid Manag
; 16(3): 167-176, 2020.
Article
en En
| MEDLINE
| ID: mdl-32421837
ABSTRACT
OBJECTIVE:
Many patients are discharged from hospital after surgery with excessive doses of opioid, and prescription opioid addiction has become a serious public health problem. Inpatient opioid de-escalation performed by clinical phar-macists may assist in reducing opioids before discharge. We aimed to evaluate whether clinical pharmacist-led opioid de-escalation for inpatients after orthopedic surgery led to significant reductions in opioid use at discharge, without resulting in greater pain intensity and side effects.DESIGN:
This retrospective pre-/post-intervention study evaluated patients before and after implementation of a phar-macist-led opioid de-escalation service.SETTING:
A major tertiary institution.PARTICIPANTS:
Ninety eight participants underwent de-escalation, and 98 controls received standard care following ortho-pedic surgery. INTERVENTION Pharmacist-led opioid de-escalation was initiated after discharge from the institution's Acute Pain Service. MAIN OUTCOMEMEASURE:
Primary outcome was total morphine oral equivalence (MOE) required in the 24-hours before discharge between the two groups. Secondary outcomes included pain intensity scores and opioid-related side effects.RESULTS:
The post-intervention group used significantly less opioids in the 24 hours preceding discharge compared with the precohort (total MOE 30 vs 45 mg; p = 0.025).There were no differences in pain intensity at rest (p = 0.19) or with movement (p = 0.19). Cases experienced significantly less constipation (29 vs 49 percent; p = 0.004); no differences were observed for other side effects.DISCUSSION:
We observed statistically similar pain intensity ratings, in the setting of significantly lowered opioid doses among the post-intervention group prior to discharge.CONCLUSION:
Pharmacist-led inpatient opioid de-escalation is effective, does not increase pain intensity, and reduces constipation. Hospitals should explore the viability of extending pharmacist-led opioid de-escalation to other surgical patients and following hospital discharge, aiming for opioid cessation.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Farmacéuticos
/
Procedimientos Ortopédicos
/
Analgésicos Opioides
Límite:
Humans
Idioma:
En
Revista:
J Opioid Manag
Asunto de la revista:
NEUROLOGIA
/
PSICOFISIOLOGIA
/
TERAPIA POR MEDICAMENTOS
Año:
2020
Tipo del documento:
Article
País de afiliación:
Australia