Multidisciplinary intervention decreases the use of opioid medication discharge packs from 2 urban EDs

Prescription opioid overdoses and deaths constitute a public health epidemic, and recent studies show that emergency department (ED) prescribers may contribute to this crisis. We hypothesized that a multidisciplinary educational intervention would decrease ED opioid packs dispensed at discharge.

This prospective study implemented a "bundle" of interdisciplinary educational modalities: lectures, journal clubs, case discussions, and an electronic medical record decision support tool. Implementation occurred in 2 urban EDs in the same health system at different times ("affiliate," September 2011; "primary," January 2012) to better distinguish its effects. The primary outcome was preintervention/postintervention change in opioid discharge packs dispensed to all patients treated and discharged through August 2012 and was assessed by 2-way analysis of variance. The secondary outcome was bivariate analysis (using Fisher exact test) of change in opioid dispensing among patients with known risk factors for prescription opioid dependence: age less than 65 years, history of substance abuse, chronic pain, or psychiatric disorders.

A total of 71,512 and 45,746 patients were evaluated and discharged from primary and affiliate EDs, respectively. Orders for opioid discharge packs decreased from 13.9% to 8.4% and 4.7% to 1.9% at the primary and affiliate hospitals (P < .0001). Dispensing among individuals at risk for opioid dependence at the primary ED decreased from 21.8% to 13.9%.

A staged, multidisciplinary intervention targeting nurses, residents, nurse practitioners, and attending physicians was associated with decreased orders for opioid discharge packs in 2 urban EDs. Opioid discharge pack orders decreased slightly more among patients with risk factors for prescription opioid dependence.