Prescribing patterns and communication for oxycodone on ED discharge

Grant ID: EMTR-200R26-2016

Project Summary

Pain is a common symptom in ED patients, and is often the primary reason patients seek emergency medical attention. There are, however, growing public health concerns that opioid medications are being increasingly and excessively prescribed for pain. These medications may have a serious side effect profile including sedation, tolerance, and development of addiction, and may subsequently be diverted in the community for non-medical use.

A recent baseline audit of local prescribing records revealed oxycodone, an opioid pain medication, is prescribed in approximately 5% of patients discharged home from this ED (with an annual census of 77,500 presentations). Clinical documentation and discharge communication was either absent, incomplete, or inconsistent when discharge plans for dosing, duration of therapy, follow-up reviews and de-escalation of therapy were analysed.

The objective of this study is to evaluate the effectiveness of an intervention for discharge oxycodone prescribing relevant to Australian Emergency Departments. The principal aims are to decrease the amount of oxycodone prescribed, improve practitioner awareness of local opioid prescribing behaviour, and improve documentation around oxycodone use on discharge. This quality assurance evaluation study will measure the success of a multifaceted oxycodone prescribing intervention and its impact on oxycodone prescribing for patients discharged home from the Emergency Department (ED). The project is hypothesized to reduce oxycodone prescribing, improve discharge documentation, and ensure appropriate follow up plans are in place.

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Outcomes

The research team developed an 'Opioid Prescribing Toolkit' focusing on changing prescribing culture from the ground up by equipping clinicians with the knowledge to discuss and facilitate non-pharmacological strategies with patients, only prescribing opioids as a small part of an overall pain management strategy, if at all.

Following a twelve-month trial of the toolkit in one emergency department, the team saw a 21 per cent relative reduction in opioid prescriptions for emergency department patients at discharge. This equated to an average decrease of six tablets per prescription.

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IMPACT

The toolkit has been endorsed by the Queensland Clinical Senate and is now being expanded to 14 other sites with 25 local teams across the state.

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Leveraged Funds

- In-kind: $26,160
- RBWH Foundation - $13,806

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Dissemination

Kline, T.V., Savage, R.L., Greenslade, J.H., Lock, C.L., Pattullo, C. and Bell, A.J., 2019. Affecting emergency department oxycodone discharge prescribing: an educational intervention. Emergency Medicine Australasia, 31(4), pp.580-586.

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Video/Presentations

ACEM ASM, Sydney, November 2017: Savage, R. ED OPIOID: Emergency department opioid prescribing intervention to optimise discharge

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