Opioid prescribing in the emergency department of a tertiary hospital: A retrospective audit of hospital discharge data

摘要

Abstract Objective EDs are a common source of prescription opioids on discharge. We explored opioid prescribing practices in an ED at a tertiary hospital in Victoria, Australia. Methods A retrospective audit over a 6 month period of patients discharged from the ED to the community with the maximum allowable quantities of prescription opioids. Results There was a total of 3301 patient‐episodes discharged with a prescription from the ED. Of these, 766 (23.2%, 95% confidence interval [CI] 21.8–24.6) were prescribed opioids, with over half discharged with the maximum allowable quantities of prescription opioids. Immediate‐release opioids were prescribed in 362 (85.8%, 95% CI 82.5–89.1) patient‐episodes, a combination of immediate‐release and slow‐release preparations were prescribed in 29 (6.9%, 95% CI 4.5–9.3) and 31 (7.3%, 95% CI 4.8–9.8) were prescribed as slow‐release opioids alone. Co‐prescription of other analgesia with opioids occurred in 152 (36.0%, 95% CI 31.4–40.6) patient‐episodes. Possible drug interactions between opioids and other medications were noted in 117 (27.7%, 95% CI 23.4–32.0) patient‐episodes. Discharge summaries were prepared for 360 (85.3%, 95% CI 81.9–88.7) patient‐episodes, but only 171 (40.5%, 95% CI 35.8–45.2) included a plan to address the opioids, be that an opioid‐weaning regimen, analgesia review or referral to a pain specialist on discharge. Conclusion Opioid prescribing was common in this ED, with almost one‐quarter of discharge prescriptions being for a prescription opioid. This audit highlights potential areas for practice improvement including review of the quantity of opioid tablets prescribed as well as an opioid plan on discharge from the ED.