Identifying Adverse Events Associated With High-Risk Opioid Administration Using the Emergency Department Trigger...

Area of Science:

• Emergency Medicine
• Patient Safety
• Pharmacovigilance

Background:

• Opioid-related adverse events (AEs) after ED discharge are known, but AEs during ED stays are less understood.
• Detecting opioid AEs in the ED is challenging due to frequent administration and non-specific surveillance.
• The Emergency Department Trigger Tool (EDTT) was evaluated for detecting AEs from high-risk opioid use within the ED.

Purpose of the Study:

• To assess the utility of the ED Trigger Tool (EDTT) for identifying opioid-related adverse events (AEs) during emergency department (ED) visits.
• To evaluate specific triggers related to high-risk opioid administration for AE detection.

Main Methods:

• A secondary analysis of a multicenter retrospective study using the EDTT.
• Two triggers were analyzed: M2 (≥3 doses of hydromorphone) and M18 (opioid + benzodiazepine administration).
• The EDTT was applied to ~3000 records per site over 18 months, with a two-tiered review process.

Main Results:

• 3.0% of visits involved high-risk opioid administration triggers (M2, M18, or both).
• Of the reviewed records with triggers, 5.3% had at least one trigger.
• Opioid-related AEs were identified in 26.2% of triggered visits, with higher rates for M2 (47.4%) than M18 (21.9%).

Conclusions:

• Approximately 5% of ED visits involved high-risk opioid administration, with 26% of these resulting in an AE.
• The EDTT proved effective for AE detection, with consistent rates across sites.
• Triggers focused on high-risk opioid administration show promise as a surveillance strategy for improving patient safety.