Article ; Online: Impact of order entry alerts and modifications on doses of intravenous opioids dispensed during a national drug shortage.
2020 Volume 77, Issue Supplement_2, Page(s) S41–S45
Abstract: Purpose: To address the intravenous (i.v.) opioid shortage, computer-based alerts and modifications were implemented over 2 phases beginning in August 2017 and February 2018, respectively. A study was conducted to assess the impact of these ... ...
| Abstract | Purpose: To address the intravenous (i.v.) opioid shortage, computer-based alerts and modifications were implemented over 2 phases beginning in August 2017 and February 2018, respectively. A study was conducted to assess the impact of these interventions on dispenses of intermittent doses of i.v. opioids during a national shortage. Methods: A retrospective, single-center, pre- and postimplementation study was conducted to compare opioid dispenses from September 2017 through December 2017 (phase 1) and March 2018 through May 2018 (phase 2) with dispenses during the same time periods of the previous year (historical control periods). Dispense data for intermittent doses of i.v. fentanyl, hydromorphone, and morphine and select oral opioids were collected from automated dispensing cabinets (ADCs) located in nonprocedural areas. The primary endpoint was the percentage of total intermittent doses of i.v. and oral opioids that were dispensed for i.v. administration. A subanalysis accounting for unit type was conducted. Key secondary endpoints were the numbers of oral and i.v. opioid dispenses by month. Results: The final analysis included data from 92 ADCs. The percentage of i.v. opioid dispenses significantly decreased, by 9.8% during phase 1 (P < 0.0001) and by 16.8% during phase 2 (P < 0.0001) compared to dispenses during the historical control periods. These decreases were significant across all unit types except pediatric units during phase 1. Average monthly dispenses of i.v. opioids were 49.9% and 74.2% fewer than dispenses during the historical control periods after the phase 1 and phase 2 implementations, respectively. Conclusion: Order entry alerts and modifications significantly decreased dispenses of intermittent doses of i.v. opioids during a national shortage, with demonstrated sustainability of decreases over 7 months. |
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| MeSH term(s) | Administration, Intravenous ; Administration, Oral ; Analgesics, Opioid/administration & dosage ; Analgesics, Opioid/supply & distribution ; Dose-Response Relationship, Drug ; Fentanyl/administration & dosage ; Humans ; Hydromorphone/administration & dosage ; Medical Order Entry Systems ; Morphine/administration & dosage ; Practice Patterns, Physicians'/statistics & numerical data ; Retrospective Studies |
| Chemical Substances | Analgesics, Opioid ; Morphine (76I7G6D29C) ; Hydromorphone (Q812464R06) ; Fentanyl (UF599785JZ) |
| Language | English |
| Publishing date | 2020-05-18 |
| Publishing country | England |
| Document type | Journal Article |
| ZDB-ID | 1224627-x |
| ISSN | 1535-2900 ; 1079-2082 |
| ISSN (online) | 1535-2900 |
| ISSN | 1079-2082 |
| DOI | 10.1093/ajhp/zxaa072 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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