Trends in Opioid Analgesic Prescribing in a Single Urban Emergency Department
Pain is the most common reason for emergency department (ED) visits, causing opioids to remain a prevalent analgesic and a linchpin for pain management in the ED. It is imperative to examine analgesic prescribing practices, especially given the continued abuse and overdose mortality from opioids. We aim to assess our ED’s opioid utilization by executing a federal grant project on opioid alternative initiatives.
Queried data points of interest from a level-one trauma ED’s electronic medical records were used to create data sets and develop unique visual dashboards concerning analgesic usage. The data was then qualitatively analyzed for prescribing trends using clinical informatics (CI).
During a 10-month reporting period (Dec. 1, 2020 – Oct. 31, 2021) for the ongoing project, 40.7% of all ED patient visits (N = 83,826) were for pain conditions, of whom 79.0% received analgesic medication treatment, in which, 25.6% received opioids compared to 74.4% receiving alternatives in the ED and at discharge (D/C). Thus far, a total of 34,117 ED pain patient visits yielded a daily average of 20.9 (N=6,995) opioid ED orders and 2.2 (N=720) opioid D/C prescriptions per 101.8 daily patient visits. Among all opioids prescribed in the ED and D/C, 90% were ordered in the ED. Intravenous (IV) morphine (59.4%), morphine sulfate immediate release (MSIR) (16.6%), IV fentanyl (11.4%), and oxycodone/acetaminophen (8.0%), comprised 95.5% of total opioid ED orders. MSIR (73.7%), oxycodone/acetaminophen (12.2%), and buprenorphine/naloxone (6.5%), comprised 92.5% of total opioid D/C prescriptions. IV and oral immediate-release opioid drug formulations are favored in our ED. The most common diagnosis groups associated with opioid dispensation were traumatic fractures (49.9%), chronic musculoskeletal pain (37.4%), and malignant pain (3.0%).
Conclusion And Implication
We accurately examined our ED’s opioid analgesic prescribing practices using CI through dashboard reporting. Such reporting easily identifies key performance indicators that can enhance pain management in the emergency setting. In our ED, opioids have considerably lower usage than non-opioids. With the ongoing prescription opioid abuse and overdose mortality, it’s crucial to reliably review analgesic prescribing in the ED as a first step to identify patterns and address this serious issue.