OPTIMIZING THE SAFE AND EFFECTIVE PRESCRIBING OF OPIOIDS FOR PAIN
MANAGEMENT IN THE EMERGENCY DEPARTMENT
Zimmerman DE, Cohen V*
Maimonides Medical Center 4802 Tenth Avenue Brooklyn, NY 11219
Opioid abuse and misuse has become an epidemic to the United States. The New York City
Department of Health and American College of Emergency Physicians have released statement positions
and recommendations for prescribing of opioid medications in the emergency department. 1,2 The goal of
these recommendations is to reduce the misuse and over prescribing of opioid medications. The Emergency
Department Clinical Pharmacist and Pharmacy Resident in coordination with a multidisciplinary team of
clinicians have developed initiatives to ensure the Maimonides Medical Center Emergency Department is
in compliance with the new recommendations. The specific areas of interest for this study include
medication orders for chronic non-malignant pain patients, concurrent benzodiazepine use, and discharge
prescriptions for opioid containing medications. The purpose of this study is to determine the effectiveness
of opioid prescribing initiatives that are aimed to reduce opioid misuse and abuse.
This study will be done by surveying and collecting information on patients with opioid orders for
chronic non-malignant pain and patients who are discharged with opioid prescriptions both before and after
the initiatives were implemented to calculate the frequency of opioid misuse. Information that will be
collected includes de-identified patient information, opioid medication(s) ordered, concurrent and home
medication(s), and basic laboratory information. Orders for chronic non-malignant pain will be considered
inappropriate if non-opioid therapies have not been attempted prior to opioid prescribing unless
contraindications to therapy are present. Discharge prescriptions will be considered inappropriate if a 6-day
supply or greater is dispensed. The initiatives consist of prescriber education, modifications to the computer
physician order entry system. An estimated 250 orders will be included in this analysis. Descriptive
statistics will be used in this analysis.
1.
Paone D, Dowell D, Heller D. Preventing misuse of prescription opioid drugs. City
Health Information. 2011;30(4):23-30.
2.
Cantril SV, Brown MD, Carlisle RJ, et al. Clinical policy: critical issues in the prescribing of opioids
for adult patients in the emergency department. Ann Emerg Med. 2012; 60:499-525.