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Preventing Harm From Opioids in Hospital Settings


Opioid-related safety events can be a deadly problem for healthcare organizations, according to ECRI Institute, Plymouth Meeting, Pa. The institute’s 2017 report, “Deep Dive: Opioid Use in Acute Care,” analyzed more than 7,200 events involving opioids over nearly three years and found often the most harmful events occurred during prescribing.

This is because different forms of opioids can cause confusion among prescribers, as each drug’s potency and clearance rates vary, says William M. Marella, executive director, operations, and analytics for patient safety, risk and quality, ECRI Institute. Current clinical decision support tool limitations also may be to blame. However, leaders can make smart use of their EHRs to help prevent safety events. As an example, he points to organizations that are modifying order sets to limit the number of formulations of opioids available for prescribers to select.

Another tactic to reduce opioid-related safety events is reviewing the causes of opioid-induced respiratory depression, which often occurs with patients on intravenous opioids during transitions from one unit to another. To avoid this safety risk providers can monitor patients for longer time periods before transferring them, says Stephanie Uses, PharmD, JD, patient safety analyst, ECRI Institute. Decision support tools can be made available for nurses that makes visible the morphine milligram equivalents their patients have on board.

ECRI Institute also recommends that healthcare executives ask their teams several questions when evaluating their opioid safety practices, including the following:

  • How might improving the safety of opioid use support our mission, vision and goals?
  • Do our culture, staffing and work environment support safe opioid use?
  • Who is responsible for opioid safety in our organization?
  • Do we engage in analysis, discussion and learning from opioid-related adverse events?
  • How do we help set realistic patient expectations regarding pain in the hospital?
  • What commonalities are there among patients who experience opioid-related adverse drug events?
  • Have we made prevention and detection of controlled substance diversion an organizational priority?
  • Do clinicians feel pressured to prescribe and administer opioids to achieve patient satisfaction?
  • What do our frontline staff do on a daily basis to facilitate safe use of opioids, and how can we support and build on those activities?

Source: “Deep Dive: Opioid Use in Acute Care,” ECRI Institute, 2017.

Laura Ramos Hegwer

In this web extra, leaders also are focusing on how to reduce opioid-related safety events among inpatients. For example, they are using EHR tools to assign morphine milligram equivalent values to drugs that patients already take to avoid potential overdoses if they receive opioids in the hospital.