Incidence and Variables Associated With Inconsistencies in Opioid Prescribing at Hospital Discharge and Its Associated Adverse Drug Outcomes

• Published in: Value in health Vol. 24; no. 2; pp. 147 - 157
• Main Authors: Kurteva, Siyana, Habib, Bettina, Moraga, Teresa, Tamblyn, Robyn
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2021; Elsevier Science Ltd
• Subjects: Aged; Aged, 80 and over; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Analgesics, Opioid - therapeutic use; Confidence intervals; Continuity of Patient Care; Critical incidents; Discharge; Drug abuse; Drug overdose; Electronic Prescribing - standards; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; Emergency services; Female; Handwriting; Health facilities; Health services utilization; hospital discharge; Humans; Male; Medication Errors - statistics & numerical data; medication reconciliation; Medication Reconciliation - standards; Middle Aged; Narcotics; opioid prescribing; Opioids; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; Practice Patterns, Physicians' - statistics & numerical data; Prescribing; Prescription drugs; Propensity; Prospective Studies; Reconciliation; Regression analysis; Substance abuse treatment; transitions in care; transitions in care; opioid prescribing; hospital discharge; medication reconciliation; opioids
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2020.07.015

Opioid-related medication errors (MEs) can have a significant impact on patient health and contribute to opioid misuse. The objective of this study was to estimate the incidence of and variables associated with the receipt of an opioid prescription and opioid-related MEs (omissions, duplications, or dose changes) at hospital discharge. We also determined rates of adverse drug events and risks of emergency department visits, readmissions, or death 30 days and 90 days post discharge associated with MEs. A cohort of hospitalized patients discharged from the McGill University Health Centre between 2014 and 2016 was assembled. The impact of opioid-related MEs was assessed in a propensity score–adjusted logistic regression models. Multivariable logistic regression was used to determine characteristics associated with MEs and discharge opioid prescription. A total of 1530 (43.9%) of 3486 patients were prescribed opioids, of which 13.4% (n = 205) of patients had at least 1 opioid-related ME. Rates of MEs were higher in handwritten prescriptions compared to the electronic reconciliation discharge prescription group (20.6% vs 1.2%). Computer-based prescriptions were associated with a 69% lower risk of opioid-related MEs (adjusted odds ratio: 0.31, 95% confidence interval: 0.14-0.65) as well as 63% lower risk of receiving an opioid prescription. Opioid-related MEs were associated with a 2.3 times increased risk of healthcare utilization in the 30 days postdischarge period (adjusted odds ratio: 2.32, 95% confidence interval: 1.24-4.32). Opioid-related MEs are common in handwritten discharge prescriptions. Our findings highlight the need for computer-based prescribing platforms and careful review of medications during critical periods of care such as hospital transitions. •Previous studies have found between 1.2 and 5.3 medication errors (MEs) per patient in transitions from the hospital to the community. Nevertheless, the occurrence of and variables associated with opioid-related errors during these care transitions is an underexplored area with most studies focusing largely on any errors, or separating medications in high-risk and low-risk groups.•Our results showed a 13% rate of opioid-related MEs for hospitalized adults. These errors were almost exclusively present in handwritten prescriptions and were largely introduced because of inaccurate medication reconciliation at time of discharge or incomplete retrieval of community medications list at admission. Computer-based prescriptions were associated with a 69% lower risk of MEs attributed to opioids. Rates of acute healthcare events in the 1 month postdischarge were twice as high in patients with opioid-related MEs such as therapy omissions, duplications, or dose changes.•Given the importance of prescription opioids in the public health crisis of opioid-related mortality, our findings highlight the potential for computer-based prescribing and medication reconciliation software for an accurate medication list and careful review of medications at transitions of care such as hospitalizations.