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Inpatient opioid prescribing

January 2014

Published in the January 2014 issue of Today’s Hospitalist

Inpatient opioid prescribing

A NEW STUDY looking at inpatient opioid prescriptions found that 51% of more than 1 million nonsurgical inpatients were prescribed at least one opioid, often at high doses.

The study, which was posted online in November by the Journal of Hospital Medicine, analyzed 2009-10 data from nearly 300 U.S. hospitals. Researchers found that 52% of patients prescribed opioids were taking the medications on the day they were discharged.

The analysis also revealed wide variations among hospitals in the percentage of nonsurgical inpatients being prescribed opioids, ranging from 33% of patients to 64%. Not surprisingly, hospitals with higher rates of opioid prescribing also had higher adjusted rates of opioid-related adverse events.

Researchers called for more studies to test interventions that can standardize opioid prescribing and enhance prescription safety. The authors pointed out that the study was one of the first to examine inpatient opioid prescribing patterns, although outpatient opioid prescriptions have received sharp scrutiny.

Beta-blockers and noncardiac surgery

ONLY SELECT CARDIAC PATIENTS should receive perioperative beta-blockers during noncardiac surgery, according to research posted online in November by JAMA Internal Medicine.

Researchers analyzed 2004-09 Danish data looking at patients with ischemic heart disease who underwent noncardiac surgery. Patients included both those with and without heart failure and those with and without a history of MI.

Researchers found that beta-blockers were associated with a significantly lower 30-day risk of major cardiovascular adverse events and mortality among patients with heart failure. But among patients without heart failure, beta-blockade was associated with a lower risk of events and mortality within 30 days only among those who had suffered an MI within the previous two years.

An editorial noted that many physicians have long believed that all patients with ischemic heart disease should receive perioperative beta-blockade. Guidelines in the U.S. recommend starting beta-blockers in patients with established coronary artery disease before they undergo noncardiac surgeries of intermediate or high risk.

Written signouts: room to improve

WHILE HOSPITALISTS covering nights frequently rely on written physician signouts to answer inquiries that crop up, those signouts “are not reliably effective” to answer most of those questions. Thats according to a study published in the November issue of the Journal of Hospital Medicine.

In the study, hospitalists and midlevels covering nights on the nonteaching service at Yale-New Haven Hospital tallied how many inquiries they received. They also counted how often they referenced written signouts to answer those questions and how many times the signout could supply the informa- tion they needed.

While hospitalists referred to written signouts for 74% of the inquiries they received, they found that the signout could sufficiently answer only 30% of those questions. Doctors consider 77% of inquiries to be either “somewhat” or “very” clinically important. Signouts were more likely to be considered sufficient to answer inquiries for patients admitted for less than two days. Signouts were less likely to help with patients who had been in the hospital longer.

Fistbumps reduce infection risk

RESEARCHERS from the West Virginia School of Medicine have identified one potential way to cut down on transmitting bacteria throughout the hospital: Stop shaking hands and move to fistbumps instead.

The research team tested that hypothesis in a pilot project. In results published in the December issue of the Journal of Hospital Infection, researchers had two health care workers move through a hospital, first shaking hands with 20 other staff members, then doing fistbumps with other health care workers. The subjects had their hands cultured after each pass through the hospital.

The research team found that shaking hands produced four times the amount of bacterial colonization as fistbumps, due to the longer contact time and larger surface area exposed when people shake hands. While hand-hy- giene initiatives have become major quality improvement projects in hospitals and are important to cut infections, researchers noted that as many as 80% of people “retain some disease-causing bacteria after washing.”