Acute pain management of patients currently on opioid substitution therapy admitted to a community hospital Kristen Nagy, Becky Szymanski, William Wright Carolinas Medical Center - Northeast - Concord, NC
Background/Purpose: To assess current prescribing practices for acute pain in patients admitted on opioid substitution therapy (OST) and identify areas for improvement, evaluate pain control during admission, and relapse rates once discharged. It may provide evidence needed to develop tools for pain management strategies to be utilized by physicians presented with patients on OST in order to improve patient care.
Methodology: This is an IRB-approved retrospective, non-interventional study of adult patients admitted to Carolinas Healthcare System (CHS) Northeast over a seven-month period in 2017 currently on OST (methadone, buprenorphine, buprenorphine/naloxone) requiring acute pain management. Patients were identified by an admission medication reconciliation database. The primary outcomes include types of pharmacotherapy utilized for pain control, pain scores during admission, and patients maintained on home OST while admitted. Secondary outcomes include total daily doses of pain medications with conversion to morphine equivalents as appropriate, patients discharged on home OST and/or prescription for pain medication, incidence of relapse as defined by physician, and rate of patients admitted with withdrawal/overdose symptoms as documented by physician.
Results: Of the twenty-three patients that met inclusion, approximately half were females, average age of 44.7 years, and weight of 83.6 kilograms. The majority of patients were Caucasian (95.7 percent) with an average length of stay of 3.3 days. Patients were admitted to surgical units (10), medical units (7), cardiology (4), and emergency department (1). Approximately 65 percent of patients had depression and 87 percent had chronic pain issues. Most patients were on buprenorphine/naloxone (60.9 percent) for more than 12 months (39.1 percent) prior to admission.
Presentation Objective: Identify pain medications utilized in patients on opioid substitution therapy.
Self-Assessment: What is the most commonly used pain medication for acute pain management in an inpatient setting?
