Are Opioid Infusions Used Inappropriately at End of Life? Results From a Quality/Safety Project.
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.Keywords
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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