Opioid prescribing and medication errors
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Opioid prescribing and medication errors Medication errors occur in a proportion of hospitalised patients, mostly due to reconciliation errors or history errors, according to study results reported in Value in Health, and are "almost exclusively present in handwritten prescriptions". The study was part of a cluster-randomised trial on discharge medication reconciliation at the McGill University Health Centre in Canada. Patients ≥18 years of age who were discharged between October 2014 and November 2016 were followed for up to 90 days. Their opioid prescription status was ascertained using patient charts or electronic reconciliation software. Adverse events were assessed by patient interviews. There were 3486 patients, with a mean age of 69.6 years; 57.7% of patients were male. Most patients were opioidna¨ıve prior to hospitalisation (65%); 72% of patients received an opioid during their hospitalisation. There were 1530 patients who were prescribed an opioid at discharge (43.9%), predominantly surgical patients. On average they received 10.5 medications each, with a mean of 7.5 changes in their community medications. An increased risk of receiving an opioid prescription was associated with increasing age, thoracic surgery, diagnosis with a pain syndrome, or receiving chemotherapy in the preceding year, while a decreased risk was associated with a computerised discharge prescription, a history of receiving analgesics, receiving an antidepressant during hospitalisation, or ≥1 ED visit in the preceding year. At least one medication error (ME) occurred in 205 patients (13.4%), most frequently unintended dose change errors (44.4%), followed by omission errors (40.0%) and therapy duplication errors (15.6%). The ME rate was higher with handwritten prescriptions (20.6%) than with electronic prescriptions (1.2%). "There were no duplication or omission errors among patients where the medication reconciliation software was used for their discharge prescription", note the authors. There was a higher risk of an opioid-related ME in patients with an active opioid prescription at admission. In the 30 days after discharge, patients with opioid-related MEs had higher rates of adverse drug events compared to patients without MEs (5.4% vs 3.9%) and higher rates of hospital readmissions (23.4% vs 8.5%) or a composite of ED visits, readmission, or death. "Given the importance of prescription opioids in the public health crisis of opioid-related mortality", note the authors, "our findings highlight the need for an accurate medication list and careful review of medications at transitions of care such as hospitalisations". Kurteva S, et al. Incidence and Variables Associated With Inconsistencies in Opioid Prescribing at Hospital Discharge and Its Associated Adverse Drug Outcomes. Value in 803517186 Health : 10 Nov 2020. Available from: URL: https://doi.org/10.1016/j.jval.2020.07.015
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Reactions 21 Nov 2020 No. 1831
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