Evaluation of opioid prescribing for surgical patients discharged from three metropolitan hospitals between 2012 and 2020.

This multicentre, retrospective medical record audit evaluated opioid analgesia prescribing within a Victorian metropolitan public hospital network. The study included all surgical patients discharged between January 2012 and December 2020 with one or more discharge prescriptions from three metropolitan hospitals (n = 117,989). The main outcome measures were mean oral morphine equivalent daily dose (OMEDD), mean number of opioid types and proportion of patients prescribed one or more slow-release opioids on discharge.Total opioid prescribing (mean OMEDD) peaked in 2013. Between 2017 and 2020 there was a trend towards prescribing fewer opioids on discharge. Over the study period, there was decreasing prescription of codeine and increasing prescription of oxycodone and tapentadol. The proportion of patients prescribed slow-release opioids increased in the earlier years of the study, reaching a peak of 20.6% in 2017. Since 2017 there has been a rapid reduction in the prescription of slow-release opioids.Subanalysis was undertaken to evaluate key changes in the opioid prescribing landscape in the health network. The removal of default opioid pack sizes in the electronic medication management system (December 2014) and the release of the Faculty of Pain Medicine-Australian and New Zealand College of Anaesthetists' statement regarding the use of opioid analgesics in patients with chronic non-cancer pain (March 2018) were associated with significant reductions in mean OMEDD prescribed on discharge (136 mg vs 122 mg and 120 mg vs 85.4 mg, respectively, P < 0.001).In conclusion, the quantity of opioids prescribed on discharge in this patient group peaked in 2013 and has been decreasing since.

Evaluating an implementation of the Australian National Guidelines for the On-Screen Display of Discharge Summaries.

Objective The objective of this study was to evaluate changes in the inclusion of pertinent information on electronic discharge summaries (eDS) after implementation of a revised template and electronic medical record (EMR) workflow. Methods A retrospective medical record audit of eDS at three metropolitan hospitals was undertaken for adult inpatient encounters in June 2021 (pre-intervention, n = 100) and June 2022 (post-intervention, n = 100). The eDS were evaluated against 16 components listed in the Australian National Guidelines for the On-Screen Display of Discharge Summaries. Nine components were further broken down to between two and 11 sub-components. Sub-analysis compared a hospital with full EMR to pooled results from hospitals with hybrid EMRs. Components and sub-components were evaluated for inclusion only; accuracy or relevance of the information was not assessed. Results Inclusion of three out of 16 components (presentation details: 47% vs 62%, problems and diagnosis: 61% vs 86% and recipient details: 82% vs 93%) and eight out of 36 sub-components (discharge destination, principal diagnosis, history of presenting complaint, infection risk, pressure injury, screening and/or diagnosis of delirium and GP phone number and address) was higher in the post-intervention group (all P < 0.05). Reduced eDS information inclusion in the post-intervention group was observed for discharge date and falls risk only (both P < 0.05). Reporting of falls history decreased at the hospital with full EMR (71% vs 20% P < 0.001) but not at hospitals utilising hybrid EMRs (24% vs 30% P = 0.5). Conclusion The intervention was associated with improved inclusion of pertinent information as described in the Australian National Guidelines for the On-Screen Display of Discharge Summaries.

Discharge summary medication list accuracy across five metropolitan hospitals: a retrospective medical record audit.

Objective To determine the accuracy of discharge summary (DS) medication lists across a broad cross-section of hospital inpatients and to determine what factors may be associated with errors in this document. Methods A retrospective medical record audit was undertaken at five metropolitan hospitals that utilise an electronic medication management system (eMMS) at the point of discharge. Four hospitals utilised an eMMS for inpatient medication management, with the fifth utilising the paper-based National Inpatient Medication Chart (NIMC). Any inpatients discharged during the first week of February, May, August and November 2020 and February 2021 were included if they received both a DS and either a pharmacy-generated patient-friendly medication list or interim medication administration chart. Results Eight-hundred and one DSs were included, of which 525 (66%) had one or more medication errors and 220 (27%) had one or more high-risk medication errors. A higher proportion of patients with polypharmacy (five or more medications) had one or more errors compared to patients without polypharmacy (67% vs 54%, P < 0.01). DSs generated from the site with paper NIMCs were less likely to have one or more errors when compared to sites using an inpatient eMMS (58% vs 68%, P < 0.01). Age, sex, language spoken and preparing the DS post-discharge were not associated with differing rates of errors. Of the 2609 individual medication errors (390 high-risk errors), the most common types were 'omitted drug or dose' (34%) and 'unnecessary drug' (33%). Conclusion Medication errors in the DS are common and more likely to occur in patients with polypharmacy.

Medication not accounted for in hospital electronic medication administration records: a retrospective observational study.

OBJECTIVE: To determine the nature, extent, and cost of discrepancies between the quantities of medications supplied to medical departments and administered to patients in public hospitals. DESIGN: Multicentre, retrospective observational study; analysis of electronic pharmacy drug management system (medication supply) and medication administration data for twenty frequently used medications. SETTING, PARTICIPANTS: Medical, surgical, and emergency department (ED) wards in each of four public hospitals in Melbourne, Victoria, during the 2019 calendar year. MAIN OUTCOME MEASURES: Discrepancy between the quantity of medication supplied and administered to patients (as proportion of medication supplied), overall and by hospital and ward type; direct cost to the hospitals of the discrepancies. RESULTS: The overall discrepancy rate (all medications, hospitals, ward types) was 19.2% (95% CI, 19.0-19.4%); overall rates by hospital ranged from 5.8% (95% CI, 5.7-5.9%) to 26.7% (95% CI, 26.6-26.9%). The discrepancies were largest for medications useful for self-treatment: oral antibiotics (eg, phenoxymethylpenicillin 250 mg capsule, 86.8%; 95% CI, 83.1-89.9%) and gastrointestinal medications (eg, ondansetron 4 mg tablet, 53.3%; 95% CI, 52.9-53.7%). Discrepancies were larger for oral than equivalent (or similar) parenteral formulations; they were generally low for controlled medications (temazepam, diazepam, oxycodone). Overall discrepancies were larger for EDs (32.3%; 95% CI, 32.2-32.5%) than for admitted patient wards, but differed between EDs (range: 25.7%; 95% CI, 25.5-26.0% to 39.5%; 95% CI, 39.2-39.7%). The estimated direct cost to hospitals of the discrepancies for the selected medications was $27 800. CONCLUSION: Substantial quantities of medications supplied to hospital wards and EDs are not accounted for in electronic administration records.

Computational study of ligand binding to protein receptors.

We have determined, for the first time, the enthalpic contributions to the energy change associated with ligand reorganization (LR) upon the binding of the same ligand to multiple sites within human serum albumine (HSA). Quantum mechanics based density functional theory (DFT) has been used for the LR calculations, which provides much better accuracy than previously used molecular mechanics methods (MM). Our findings show that for some ligands these enthalpic contributions can be attributed to specific structural and conformational changes.