Impact of order entry alerts and modifications on doses of intravenous opioids dispensed during a national drug shortage

Opioid Prescription in Ophthalmology and the Impact of a Decision Support Tool in Reducing Excess Dosing

PURPOSE

To characterize opioid prescribing in ophthalmology and to determine the impact of an alert system on opioid prescription patterns.

DESIGN

Retrospective pre- and post-implementation study METHODS: : The study population included individuals over the age of 18 that received opioids written by ophthalmologists within a tertiary care center between January 3, 2015 and November 3, 2021, in the context of an opioid alert system. Mean morphine equivalent daily dose (MEDD) per prescription was compared before and after implementation of the opioid alert system. Additionally, mean MEDD per prescription was compared based on patient demographics and diagnoses.

RESULTS

A total of 8,014 individual patients were included in this study. The study population received a total of 9,055 prescriptions, seventy seven percent of which were written for pain management related to an ophthalmic surgery. Mean MEDD per prescription decreased by 15.17 after implementation of the alert system (p < 0.001). A higher mean MEDD per prescription was observed among males (33.53 MEDD; p < 0.001). Black individuals received a higher mean MEDD per prescription (33.93 MEDD) compared to white individuals (32.80 MEDD; p = 0.03). Opioids written for disorders of the eyelid, lacrimal system, and orbit constituted 57.4% of total prescriptions.

CONCLUSIONS

Prescription patterns based on patient demographics and diagnoses can provide foci for opioid prescription reform in ophthalmology. The observed decrease in opioid dosage may indicate realization of the alert system.

Acupuncture and Traditional Chinese Veterinary Medicine in Zoological and Exotic Animal Medicine: A Review and Introduction of Methods

Acupuncture has been used extensively in domestic animal medicine to treat a variety of medical conditions and diseases as an adjunct or primary therapy. Exotic animals are becoming increasingly common as pets. Owners are expecting therapies for these non-domestic animals to be similar to those available to their other domestic pets. Additionally, zoological and aquatic facilities provide medical care for the entire lives of the animals that are housed in their facilities. Many conditions similar to those observed in domestic animals can develop in zoological species and can benefit from treatment with acupuncture. Through operant conditioning or routine medical examinations, the use of acupuncture as an adjunct therapy is becoming more common. The following paper presents a summary of the types of non-domestic animals treated, for which conditions, and how these methods are commonly used.

Practice-enhancing publications about the medication-use process in 2020

DISCLAIMER

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE

This article identifies, prioritizes, and summarizes published literature on the medication-use process (MUP) from calendar year 2020 that can impact health-system pharmacy daily practice.

SUMMARY

The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The MUP is defined in this article as having the following components: prescribing/transcribing, dispensing, administration, and monitoring. Articles evaluating at least one step of the MUP were assessed for their usefulness in practice improvement. A PubMed search for articles published in calendar year 2020 was conducted in January 2021 using targeted Medical Subject Headings (MeSH) keywords, and the table of contents of selected pharmacy journals was searched, providing a total of 9,433 articles. A thorough review identified 49 potentially practice-enhancing articles: 15 for prescribing/transcribing, 10 for dispensing, 6 for administration, and 18 for monitoring. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of why they are important within health-system pharmacy. The other articles are listed for further review and evaluation.

CONCLUSION

It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article assists in identifying and summarizing the most impactful recently published literature. Health-system pharmacists have an active role in improving the MUP in their institution, and awareness of the moist significant published studies can assist in changing practice at the institutional level.

Evaluation of Acute Postoperative Pain Management During an Injectable Opioid Shortage

BACKGROUND

Drug product shortages, including injectable opioids, are common and have the potential to adversely affect patient care.

OBJECTIVE

To evaluate the impact of an injectable opioid shortage for hospitalized adult patients in the acute postoperative setting.

METHODS

A single-center, retrospective cohort study of noncritically ill hospitalized, postoperative patients requiring opioids for acute pain management was conducted. Patient cohorts were compared preshortage and postshortage for proportion of total intravenous (IV) opioids used, proportions of specific pain medications used, subjective pain scores, 30-day mortality, respiratory depression, need for opioid reversal, hospital length of stay, and opioid equivalent doses.

RESULTS

A total of 275 patients were included, 130 patients in the preshortage cohort and 145 in the postshortage cohort. The proportion of total IV opioid doses was lower in the postshortage cohort versus the preshortage cohort (16.6% vs 20.5%; P < 0.01). Specific medications used were significantly different between the cohorts. The proportion of severe pain scores was lower in the postshortage cohort versus the preshortage cohort (55.6% vs 58.5%; P = 0.04). No significant differences were seen in the overall proportion of nonopioid analgesic use, 30-day mortality, respiratory depression, need for emergent opioid reversal, hospital length of stay, or opioid equivalent doses between cohorts.

CONCLUSION AND RELEVANCE

In hospitalized, postoperative adults, an injectable opioid shortage was associated with significant decreases in IV opioid use and severe pain scores but no significant differences in nonopioid analgesic use, safety outcomes, or opioid equivalent doses. These results may assist clinicians in developing strategies for injectable opioid shortages and generating hypotheses for future studies.