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

Opioid-related adverse events (AEs) resulting in or following an ED visit are well described. Less is known about AEs due to opioid administration in the ED, whose detection is limited by the high frequency of administration and poorly specific surveillance methods. We studied the use of the ED Trigger Tool (EDTT) for detection of AEs from high-risk opioid administration in the ED.

This is a secondary analysis of a multicenter retrospective study of the EDTT for two selected triggers: M2- ≥ 3 doses of hydromorphone administered and M18- opioid + benzodiazepine administration. We applied the EDTT to an 18-month extract of data from three sites and reviewed a balanced sample of ~3000 records/site using a two-tiered approach, characterizing opioid-related AEs by occurrence, type, and severity. Analysis is descriptive.

A total of 13,601/450,852 visits (3.0%) across three sites included one of these triggers: M2 (6447; 1.4%); M18 (6201; 1.4%); or both (853; 0.2%). In our sample of 8719 records, 458 (5.3%) included at least one of these triggers (78 with M2, 347 with M18, and 33 with both). Reviewer agreement was high (Kappa = 0.94). We identified 124 opioid-related ED AEs among 120 triggered visits (26.2%): M2 (37/78 visits; 47.4%); M18 (76/347 visits; 21.9%), and both (7/33 visits; 21.2%). There were no site differences in opioid-related ED AE detection. Common AEs included hypotension, hypoxia, allergic reactions, and delirium, mostly resulting in temporary harm but 30% requiring urgent intervention.

In our sample, 5% of visits included high-risk opioid administration, of which 26% included an opioid-related AE. AE rates were similar across sites, with expected variability in type and severity across triggers and sites. The EDTT is a useful approach for AE detection. Triggers focusing on high-risk opioid administration may have a more favorable yield as a surveillance strategy.