Morristown, NJ; Emergency Medical Associates, Parsippany, NJ; NJ Poison Information and Education System, NJ ... The Permanente Medical Group and Kaiser Permanente Division of Research,. Oakland, CA. Study Objectives: Sedation is ...
Research Forum Abstracts there”; “waste not want not”); and plans to keep pills specifically for “emergencies” or to avoid seeking emergent care (“Save them for emergencies, I’m accident prone”). Conclusions: Patients note diverse reasons for keeping their unused opioid pills. Awareness of the range of intentions underlying patient motivations provides critical information for future development of tailored risk communication messages to improve opioid disposal.
205
Opioid Prescriptions Given in the Emergency Department Have Decreased from 2015 to 2017
Jean-Noel N, Calichman M, Eskin B, Allegra JR, Calello D/Morristown Medical Center, Morristown, NJ; Emergency Medical Associates, Parsippany, NJ; NJ Poison Information and Education System, NJ Medical School, Rutgers Biomedical Health Sciences, Newark, NJ
Study Objectives: After introduction of pain as a “fifth vital sign,” physicians were encouraged to treat pain more effectively. Unfortunately, this has led to an increase in prescriptions for opioids, opioid addiction and deaths due to opioids. This has been reported extensively in the medical literature and the lay press. We hypothesize that due to the increased awareness of the opioid problem, emergency department (ED) physicians have reduced prescribing of opioids. Methods: Design: Retrospective multihospital cohort of ED visits. Setting: Four New Jersey suburban and urban EDs with annual visits from 30,000 to 90,000. Population: Consecutive patients seen by emergency physicians from 1/1/2014 to 4/30/ 2017. Protocol: We identified patients given a prescription for opioids and the specific opioid using an electronic medical record. Data Analysis: We computed and plotted the number of prescriptions for opioids for each month over the time period of the study correcting for length of month. We calculated the change and 95% confidence interval (CI) for the months with the highest and lowest number of prescriptions for opioids. Results: Of the 821,292 patients in the database, 53,448 (6.5%) received opioid prescriptions. The median age of patients prescribed opioids was 41 years (interquartile range, 30 to 53 years); 51% were female. Of the total opioid prescriptions, 87% contained rapid-release oxycodone, 9% codeine, 3% hydrocodone, 0.2% hydromorphone and 0.1%, long-acting oxycodone. Examination of the plot showed no clear trend before May 2015. Thereafter there was a decline in the monthly opioid prescriptions. From May 2015, the month with the highest number of prescriptions, to April 2017, the month with the lowest number, there was a statistically significant decrease of 56% (95% CI; 52%-59%) in the number of opioid prescriptions. Conclusions: From May 2015 to April 2017 the number of monthly opioid prescriptions given in the ED markedly decreased. We speculate that this is due to increased awareness by ED physicians of the opioid problem.
participate in deep sedation cases. Evidence is lacking, however, that a two-physician approach improves safety outcomes. We compared the safety of ED procedural sedation between a twophysician and a single-physician policy in a small, single-coverage community ED. Methods: This is a before/after single-center observational study of prospectively collected data from January 2013 through December 2016. The study population included a consecutive series of ED patients of any age who received procedural sedation for any indication during the study period. Data collection occurred within the context of a facility-wide quality assurance and process improvement program that included standardization of sedation data reporting and monthly structured safety audits of all procedural sedation cases in the medical center. In 2012 a policy was implemented which required two physicians to participate in deep sedations in the ED. Given the practice environment in this small single-coverage community ED, it was frequently impractical to have two physicians reliably available for time-sensitive urgent, and often emergent, procedures in the ED. This led to impaired delivery of modern, high-quality ED sedation services, most notably delays in patient care. In September 2014, our medical center switched from a two-physician policy to a single-physician policy requiring only one emergency physician, accompanied by a sedation-trained ED registered nurse, and often a respiratory therapist. The primary outcome was a sedation-related escalation of care that resulted in one of the following adverse events: dysrhythmia (symptomatic bradycardia or ventricular arrhythmias), cardiac arrest, endotracheal intubation, or unanticipated hospitalization. Secondary outcomes included hypoxemia (peripheral oxygen saturation less than 90% for greater than one minute), the need for bag-valve mask ventilation (BVM), use of a reversal agent, laryngospasm or pulmonary aspiration. Results: We performed 381 sedations during the study period: 135 patients in the two-physician group (before) and 246 patients in the single-physician group (after). The two groups were comparable in age and sex. Procedures for which sedation was indicated were similar between the groups, with joint or fracture reductions being the most common. Deep and dissociative sedation was more commonly employed in both groups, but was significantly more common in the single-physician group than the two-physician group (93% vs 68%, p
