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Emergency department opioid discharge instructions: a multidisciplinary national Delphi study
Nathaniel M Murray1, Krishan Yadav2,3, Raoul Daoust4,5
1The University of Ottawa, Ottawa, ON, Canada. nmurray@toh.ca.
CJEM
|August 15, 2022
Summary
Canadian emergency departments need standardized opioid discharge instructions. A national expert panel developed 21 key concepts for safe opioid prescribing and use, addressing medication minimization and safety. This consensus aims to improve patient care and reduce risks.
Area of Science:
- Emergency Medicine
- Pharmacology
- Health Policy
Background:
- No existing Canadian guidelines for emergency department (ED) opioid discharge instructions.
- Inadequate instructions for opioid prescriptions pose significant risks to patients.
- Need for standardized, evidence-based discharge information for opioid medications.
Purpose of the Study:
- Develop Canadian consensus on essential elements for written opioid discharge instructions in the ED.
- Establish interdisciplinary agreement on key concepts for safe opioid prescribing.
- Improve patient understanding and safe use of opioid medications post-discharge.
Main Methods:
- Modified Delphi study conducted from May to August 2021.
- National multidisciplinary panel of 23 healthcare professionals and 1 patient partner.
- Three rounds of online surveys with consensus defined by a disagreement index < 1.
Main Results:
- Unanimous consensus (100% response rate) that all ED patients receiving opioid prescriptions need written discharge instructions.
- Consensus achieved on 21 out of 23 concepts for opioid discharge instructions.
- Highest agreement on concepts related to minimizing opioid use and ensuring opioid safety (e.g., drug interactions, safe storage, impairment risks).
Conclusions:
- A national, multidisciplinary consensus identified 21 essential concepts for ED opioid discharge instructions.
- These guidelines provide a foundation for standardized, safe opioid prescribing practices in Canadian EDs.
- Implementation of these instructions can enhance patient safety and responsible opioid medication management.
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