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Are Opioid Infusions Used Inappropriately at End of Life? Results From a Quality/Safety Project.
Yeh, Jonathan C; Chae, Sul Gi; Kennedy, Peter J; Lien, Cindy; Malecha, Patrick W; Han, Harry J; Buss, Mary K; Lee, Kathleen A.
  • Yeh JC; Section of Palliative Care, Division of General Medicine and Primary Care (J.C.Y, S.G.C., P.J.K., C.L., P.W.M., H.J.H., K.A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: jyeh3@bidmc.harvard.edu.
  • Chae SG; Section of Palliative Care, Division of General Medicine and Primary Care (J.C.Y, S.G.C., P.J.K., C.L., P.W.M., H.J.H., K.A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
  • Kennedy PJ; Section of Palliative Care, Division of General Medicine and Primary Care (J.C.Y, S.G.C., P.J.K., C.L., P.W.M., H.J.H., K.A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
  • Lien C; Section of Palliative Care, Division of General Medicine and Primary Care (J.C.Y, S.G.C., P.J.K., C.L., P.W.M., H.J.H., K.A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
  • Malecha PW; Section of Palliative Care, Division of General Medicine and Primary Care (J.C.Y, S.G.C., P.J.K., C.L., P.W.M., H.J.H., K.A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
  • Han HJ; Section of Palliative Care, Division of General Medicine and Primary Care (J.C.Y, S.G.C., P.J.K., C.L., P.W.M., H.J.H., K.A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
  • Buss MK; Division of Palliative Care (M.K.B.), Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.
  • Lee KA; Section of Palliative Care, Division of General Medicine and Primary Care (J.C.Y, S.G.C., P.J.K., C.L., P.W.M., H.J.H., K.A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
J Pain Symptom Manage ; 64(3): e133-e138, 2022 09.
Article in English | MEDLINE | ID: covidwho-1996385
ABSTRACT
CONTEXT Opioid continuous infusions are commonly used for end-of-life (EOL) symptoms in hospital settings. However, prescribing practices vary, and even the recent literature contains conflicting protocols and guidelines for best practice.

OBJECTIVES:

To determine the prevalence of potentially inappropriate opioid infusion use for EOL comfort care at an academic medical center, and determine if inappropriate use is associated with distress.

METHODS:

Through literature review and iterative interdisciplinary discussion, we defined three criteria for "potentially inappropriate" infusion use. We conducted a retrospective, observational study of inpatients who died over six months, abstracting demographics, opioid use patterns, survival time, palliative care (PC) involvement, and evidence of patient/caregiver/staff distress from the electronic medical record.

RESULTS:

We identified 193 decedents who received opioid infusions for EOL comfort care. Forty-four percent received opioid infusions that were classified as "potentially inappropriate." Insufficient use of as-needed intravenous opioid boluses and use of opioid infusions in opioid-naïve patients were the most common problems observed. Potentially inappropriate infusions were associated with more frequent patient (24% vs. 2%; P < 0.001) and staff distress (10% vs. 2%; P = 0.02) and were less common when PC provided medication recommendations (20% vs. 50%; P < 0.001).

CONCLUSION:

Potentially inappropriate opioid infusions are prevalent at our hospital, an academic medical center with an active PC team and existing contracts for in-hospital hospice care. Furthermore, potentially inappropriate opioid infusions are associated with increased patient and staff distress. We are developing an interdisciplinary intervention to address this safety issue.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Terminal Care / Opioid-Related Disorders Type of study: Observational study / Prognostic study / Reviews Limits: Humans Language: English Journal: J Pain Symptom Manage Journal subject: Neurology / Psychophysiology / Therapeutics Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Terminal Care / Opioid-Related Disorders Type of study: Observational study / Prognostic study / Reviews Limits: Humans Language: English Journal: J Pain Symptom Manage Journal subject: Neurology / Psychophysiology / Therapeutics Year: 2022 Document Type: Article