In a recent study published in JAMA Internal Medicine, researchers at Yale New Haven Hospital found that educating inpatient prescribers on the benefits of oral and subcutaneous administration of opioids versus IV administration can reduce the amount of opioids dispensed. In the study, the research team rolled out a new standard of opioid administration and educated providers over a three-month period, resulting in a drop of morphine milligram equivalents (MMEs) per patient-day and a reduction in parenteral opioid use.

Perspective on the study

During the three-month study period, researchers focused on a general 28-bed medical adult inpatient unit. The patients studied were stable and excluded those undergoing procedures, those who had trauma and those who were in the ICU. While not addressing the use of all opioids, the study looked at injectable doses of morphine and hydromorphone versus oral doses of morphine, hydromorphone, oxycodone, and tramadol.

The study’s objectives were to:

1) Educate providers on the unit to the benefits of oral and subcutaneous administration of opioids versus IV administration via the default “IV push” button on electronic health record orders for parenteral opioids

2) Establish the oral route of opioids as a preferred method of administration and  subcutaneous route, versus IV delivery, as a plan B if oral meds could not be taken.

Researchers evaluated two outcomes:

1) Primary – the number of intravenous doses administered per patient-day

2) Secondary – the rates of opioids administered by any route, morphine milligram equivalents (MMEs) to determine how much drug was administered and patient pain scores

Results

By educating providers and establishing a preferred oral route of opioid administration, researchers found opioid consumption via any route, oral or injectable, was reduced by 23 percent (overall exposure). When patients received an opioid by injection intravenously or subcutaneously, the mean dose per day increased by 17 percent.

CPS Takeaways

First, this study advocated an IV to oral initiative in patients who met criteria, which aligns with CPS’ long established IV to oral core initiative; inclusive of opioids/analgesics amongst other medications. CPS has defined numerous resources that support this initiative along with pain management and opioid stewardship programs that include proprietary software, formalized assessment and education programs, policies and procedures, outcome measures, patient criteria and supporting literature.

Second, since education and competency development are critical in any quality improvement initiative, CPS’ pain management and opioid stewardship program is inclusive of educational and supplemental assessment, treatment and monitoring resources on the topic of safe and appropriate use of pain agents, including opioids.

Lastly, CPS has developed an opioid monitor which is able to evaluate injectable versus non-injectable usage trends for hospital and health system clients. This monitor includes all medications that contain an opioid, not just the ones evaluated by this study.

For more information on how CPS can help your organization address opioid management, visit CPSpharm.com.