scholarly journals 149. Impact of Stewardship on Antibiotic Utilization Rates During the COVID-19 Pandemic: Successes and Challenges in a Regional Hospital

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S186-S187
Author(s):  
Ana Macias ◽  
Jennifer Elgin ◽  
Donna Duerson ◽  
Cirle A Warren
Keyword(s):  
Healthcare Providers ◽  
Community Acquired Pneumonia ◽  
Regional Hospital ◽  
Teaching Hospitals ◽  
Prescribing Practices ◽  
Antibiotic Utilization ◽  
Appropriate Prescribing ◽  
Index Hospital ◽  
Successes And Challenges ◽  
Local Antibiotic

Abstract Background Antibiotic stewardship (AS) is at the core of patient safety and prevention of antimicrobial resistance. Healthcare providers prescribe antibiotics for COVID-19 despite low rates of bacterial co-infection. Our regional hospital had antibiotic utilization (AU) rates higher than other health systems even prior to the emergence of SARS-Cov2. We analyzed the effect AS on AU during the pandemic. Total Antibiotic Utilization Rates Before and During COVID-19 Pandemic Methods Total and specific AU rates were benchmarked using BD MedMined’s medication analytics system from 2nd quarter 2019 to 1st quarter 2021. The AS team released yearly antibiogram and individual prescriber’s AU rates and performed weekly, and as needed, review of antibiotic ordering and feedback. To assist in appropriate prescribing decisions, remote educational sessions or mini-lectures and local antibiotic guidelines were developed during the pandemic period. AU rates were monitored quarterly to determine the effects of the AS interventions to prescribing practices. Results Total and specific AU rates were higher (up to 34% and 80%, respectively) in our index hospital compared to other non-teaching hospitals nationally prior to the pandemic. Total antibiotic utilization increased by only 5.5% in the 2nd quarter 2020, peak of AU during the pandemic. Total, vancomycin, piperacillin-tazobactam and quinolone utilization rates decreased by 19%, 41%, 38%, and 52%, respectively, at 1st quarter 2021 compared to 4th quarter 2019. Steeper decreases were noted with implementation of educational activities. Ceftriaxone use remained high and was 50% greater than comparator hospitals at 1st quarter 2021. Conclusion Although problematic during the COVID-19 pandemic, AS can have significant impact on provider prescribing practices and decrease total and specific antibiotic utilization rates. The use of ceftriaxone, an antibiotic commonly used for empiric bacterial coverage for community acquired pneumonia, presents as a continuing challenge. Disclosures All Authors: No reported disclosures

scholarly journals Gambaran dan Rasionalitas Penggunaan Antibiotik pada Pasien Dewasa dengan Community Acquired Pneumonia di RSUP Prof. Dr. R. D. Kandou Manado Periode Juni 2017-Mei 2018

2018 ◽  
Vol 6 (2) ◽  
Author(s):  
Dimas Prakoso ◽  
Jimmy Posangi ◽  
Edward Nangoy
Keyword(s):  
Random Sampling ◽  
Healthcare Providers ◽  
Simple Random Sampling ◽  
Community Acquired Pneumonia ◽  
Adult Patients ◽  
Beta Lactam ◽  
Cross Sectional ◽  
Antibiotic Utilization ◽  
General Drug ◽  
Cross Sectional Design

Abstract: Irrational utilization of antibiotic led to several burdens for healthcare providers, one of them is antibiotic resistance. Community acquired pneumonia (CAP) has increased mortality rate due to irrational antibiotic utilization. This study was aimed to obtain a general depiction and antibiotic rational utilization quantitatively assessed of CAP in adult patients at Prof. Dr. R. D. Kandou Hospital Manado from June 2017 to May 2018. This was a retrospective descriptive study with a cross sectional design. Samples were 42 patients with CAP obtained by using simple random sampling. The results showed that values of DDD/100 inpatient days were, as follows: beta-lactam (33), macrolides (13.758), and fluoroquinolone (20.072). According to the ratio between estimated DDD value of Prof. Dr. R. D. Kandou and DDD WHO, all prescribed antibiotics had DDD values below or close to the value of DDD WHO. Albeit, there were discrepancies between antibiotic utilization in the field and reccomendation of Clinical Practice Guideline of Internal Medicine Department. Conclusion: Within the period of June 2017 - May 2018 the most prescribed antibiotic classes for CAP in adult patients at Prof. Dr. R. D. Kandou Hospital were beta-lactam, macrolides, and fluoroquinolone meanwhile the most prescribed antibiotics were ceftriaxone and azithromycin. In general, drug utilization was rational assessed quantitatively by using DDD WHO criteria.Keywords: antibiotic rationality, CAP, DDD WHO, Prof. Dr. R. D. Kandou Abstrak: Penggunaan antibiotik yang tidak rasional dapat membebani tenaga kesehatan, salah satunya ialah resistensi antibiotik. Community acquired pneumonia (CAP) mengalami peningkatan mortalitas tinggi akibat penggunaan antibiotik yang tidak tepat. Penelitian ini bertujuan untuk mendapatkan gambaran umum dan penilaian rasionalitas secara kuantitatif dari penggunaan antibiotik pada pasien dewasa dengan CAP di RSUP Prof. Dr. R. D. Kandou Manado periode Juni 2017-Mei 2018. Jenis penelitian ialah deskriptif retrospektif dengan desain potong lintang. Sampel sebanyak 41 pasien dewasa dengan CAP diambil dengan simple random sampling. Hasil penelitian mendapatkan DDD/100 hari rawat inap penggunaan antibiotik dari tiga golongan antibiotik yaitu beta-lactam (33), makrolida (13,758), dan florokuinolon (20,072). Berdasarkan rasio estimasi DDD di RSUP Prof. Dr. R. D. Kandou Manado dan DDD WHO seluruh obat yang digunakan masih berada di bawah DDD WHO atau mendekati nilai tersebut. Terdapat perbedaan antara penggunaan antibiotik di lapangan dan rekomendasi dari Panduan Praktek Klinis dari Bagian Ilmu Penyakit Dalam. Simpulan: Pada periode Juni 2017 - Mei 2018 golongan antibiotik yang paling banyak diberikan untuk pasien dewasa dengan CAP di RSUP Prof. Dr. R. D. Kandou Manado ialah beta-lactam, diikuti makrolida dan florokuinolon sedangkan antibiotik yang paling banyak diberikan ialah ceftriaxone dan azithromisin. Secara keseluruhan penggunaan obat sudah rasional secara kuantitatif diukur dengan kriteria DDD WHO.Kata kunci: rasionalitas antibiotik, CAP, DDD WHO, RSUP Prof. Dr. R. D. Kandou Manado

scholarly journals Identifying Patterns of Symptom Distress in Pregnant Women: A Pilot Study

2021 ◽  
Vol 18 (12) ◽  
pp. 6333
Author(s):  
Ching-Fang Lee ◽  
Fur-Hsing Wen ◽  
Yvonne Hsiung ◽  
Jian-Pei Huang ◽  
Chun-Wei Chang ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Healthcare Providers ◽  
First Trimester ◽  
Symptom Distress ◽  
Teaching Hospitals ◽  
Lower Back ◽  
Distress Symptoms ◽  
Related Symptom ◽  
Experienced Symptom

During pregnancy, a woman’s enlarged uterus and the developing fetus lead to symptom distress; in turn, physical and psychological aspects of symptom distress are often associated with adverse prenatal and birth outcomes. This study aimed to identify the trends in the trajectory of these symptoms. This longitudinal study recruited 95 pregnant women, with a mean age of 32 years, from the prenatal wards of two teaching hospitals in northern Taiwan. Symptom distress was measured by a 22-item scale related to pregnancy-induced symptoms. The follow-up measurements began during the first trimester and were taken every two to four weeks until childbirth. More than half of the pregnant women experienced symptom distress manifested in a pattern depicted to be “Decreased then Increased” (56.8%). Other noticeable patterns were “Continuously Increased” (28.4%), “Increased then Decreased” (10.5%) and “Continuously Decreased” (4.2%), respectively. It is worth noting that most pregnant women recorded a transit and increase in their symptom distress, revealed by their total scores, at the second trimester (mean 22.02 weeks) of pregnancy. The participants’ major pregnancy-related distress symptoms were physical and included fatigue, frequent urination, lower back pain, and difficulty sleeping. The mean scores for individual symptoms ranged from 2.32 to 3.61 and were below the “moderately distressful” level. This study provides evidence that could be used to predict women’s pregnancy-related symptom distress and help healthcare providers implement timely interventions to improve prenatal care.

scholarly journals Qualitative investigation of trace-based communication: how are traces conceptualised in healthcare teamwork?

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038406
Author(s):  
Sayra Cristancho ◽  
Emily Field
Keyword(s):  
Internal Medicine ◽  
Healthcare Providers ◽  
Constructivist Grounded Theory ◽  
Teaching Hospitals ◽  
Secondary Outcome ◽  
Qualitative Investigation ◽  
Qualitative Nature ◽  
Saving Face ◽  
Critical Process ◽  
Biological Literature

ObjectivesThis interview-based qualitative study aims to explore how healthcare providers conceptualise trace-based communication and considers its implications for how teams work. In the biological literature, trace-based communication refers to the non-verbal communication that is achieved by leaving ‘traces’ in the environment and other members sensing them and using them to drive their own behaviour. Trace-based communication is a key component of swam intelligence and has been described as a critical process that enables superorganisms to coordinate work and collectively adapt. This paper brings awareness to its existence in the context of healthcare teamwork.DesignInterview-based study using Constructivist Grounded Theory methodology.SettingThis study was conducted in multiple team contexts at one of Canada’s largest acute-care teaching hospitals.Participants25 clinicians from across professions and disciplines. Specialties included surgery, anesthesiology, psychiatry, internal medicine, geriatrics, neonatology, paramedics, nursing, intensive care, neurology and emergency medicine.InterventionNot relevant due to the qualitative nature of the study.Primary and secondary outcomeNot relevant due to the qualitative nature of the study.ResultsThe dataset was analysed using the sensitising concept of ‘traces’ from Swarm Intelligence. This study brought to light novel and unique elements of trace-based communication in the context of healthcare teamwork including focused intentionality, successful versus failed traces and the contextually bounded nature of the responses to traces. While participants initially felt ambivalent about the idea of using traces in their daily teamwork, they provided a variety of examples. Through these examples, participants revealed the multifaceted nature of the purposes of trace-based communication, including promoting efficiency, preventing mistakes and saving face.ConclusionsThis study demonstrated that clinicians pervasively use trace-based communication despite differences in opinion as to its implications for teamwork and safety. Other disciplines have taken up traces to promote collective adaptation. This should serve as inspiration to at least start exploring this phenomenon in healthcare.

scholarly journals Influenza With an Infiltrate: Investigating the New Community-Acquired Pneumonia Guidelines

2020 ◽  
Vol 41 (S1) ◽  
pp. s302-s302
Author(s):  
Amanda Barner ◽  
Lou Ann Bruno-Murtha
Keyword(s):  
Demographic Data ◽  
Retrospective Chart Review ◽  
Vaccination Rate ◽  
Community Acquired Pneumonia ◽  
Teaching Hospitals ◽  
Antibiotic Prescribing ◽  
Supporting Evidence ◽  
Radiographic Findings ◽  
Significant Difference ◽  
The Impact

Background: The Infectious Diseases Society of America released updated community-acquired pneumonia (CAP) guidelines in October 2019. One of the recommendations, with a low quality of supporting evidence, is the standard administration of antibiotics in adult patients with influenza and radiographic evidence of pneumonia. Procalcitonin (PCT) is not endorsed as a strategy to withhold antibiotic therapy, but it could be used to de-escalate appropriate patients after 48–72 hours. Radiographic findings are not indicative of the etiology of pneumonia. Prescribing antibiotics for all influenza-positive patients with an infiltrate has significant implications for stewardship. Therefore, we reviewed hospitalized, influenza-positive patients at our institution during the 2018–2019 season, and we sought to assess the impact of an abnormal chest x-ray (CXR) and PCT on antibiotic prescribing and outcomes. Methods: We conducted a retrospective chart review of all influenza-positive admissions at 2 urban, community-based, teaching hospitals. Demographic data, vaccination status, PCT levels, CXR findings, and treatment regimens were reviewed. The primary outcome was the difference in receipt of antibiotics between patients with a negative (<0.25 ng/mL) and positive PCT. Secondary outcomes included the impact of CXR result on antibiotic prescribing, duration, 30-day readmission, and 90-day mortality. Results: We reviewed the medical records of 117 patients; 43 (36.7%) received antibiotics. The vaccination rate was 36.7%. Also, 11% of patients required intensive care unit (ICU) admission and 84% received antibiotics. Moreover, 109 patients had a CXR: 61 (55.9%) were negative, 29 (26.6%) indeterminate, and 19 (17.4%) positive per radiologist interpretation. Patients with a positive PCT (OR, 12.7; 95% CI, 3.43–60.98; P < .0007) and an abnormal CXR (OR, 7.4; 95% CI, 2.9–20.1; P = .000003) were more likely to receive antibiotics. There was no significant difference in 30-day readmission (11.6% vs 13.5%; OR, 0.89; 95% CI, 0.21–3.08; P = 1) and 90-day mortality (11.6% vs 5.4%; OR, 2.37; 95% CI, 0.48–12.75; P = .28) between those that received antibiotics and those that did not, respectively. Furthermore, 30 patients (62.5%) with an abnormal CXR received antibiotics and 21 (43.7%) had negative PCT. There was no difference in 30-day readmission or 90-day mortality between those that did and did not receive antibiotics. Conclusions: Utilization of PCT allowed selective prescribing of antibiotics without impacting readmission or mortality. Antibiotics should be initiated for critically ill patients and based on clinical judgement, rather than for all influenza-positive patients with CXR abnormalities.Funding: NoneDisclosures: None

scholarly journals Disease characteristics and management of hospitalised adolescents and adults with community-acquired pneumonia in China: a retrospective multicentre survey

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018709 ◽  
Author(s):  
Liang Chen ◽  
Fei Zhou ◽  
Hui Li ◽  
Xiqian Xing ◽  
Xiudi Han ◽  
...  
Keyword(s):  
Southern China ◽  
Pneumonia Severity Index ◽  
Community Acquired Pneumonia ◽  
Teaching Hospitals ◽  
Secondary Outcome ◽  
Standard Case ◽  
Risk Class ◽  
Illness Onset ◽  
Hospitalised Patients ◽  
Clinical Stability

ObjectivesTo describe the clinical characteristics and management of patients hospitalised with community-acquired pneumonia (CAP) in China.DesignThis was a multicentre, retrospective, observational study.Setting13 teaching hospitals in northern, central and southern China from 1 January 2014 to 31 December 2014ParticipantsInformation on hospitalised patients aged ≥14 years with radiographically confirmed pneumonia with illness onset in the community was collected using standard case report forms.Primary and secondary outcome measuresResource use for CAP management.ResultsOf 14 793 patients screened, 5828 with radiographically confirmed CAP were included in the final analysis. Low mortality risk patients with a CURB-65 score 0–1 and Pneumonia Severity Index risk class I–II accounted for 81.2% (4434/5594) and 56.4% (2034/3609) patients, respectively. 21.7% (1111/5130) patients had already achieved clinical stability on admission. A definite or probable pathogen was identified only in 12.7% (738/5828) patients. 40.9% (1575/3852) patients without pseudomonal infection risk factors received antimicrobial overtreatment regimens. The median duration between clinical stability to discharge was 5.0 days with 30-day mortality of 4.2%.ConclusionsThese data demonstrated the overuse of health resources in CAP management, indicating that there is potential for improvement and substantial savings to healthcare systems in China.Trial registration numberNCT02489578; Results.

Diffuse alveolar haemorrhage secondary to haemophilus influenzae in a vaping patient

2021 ◽  
Vol 14 (6) ◽  
pp. e242701
Author(s):  
Aahd Kubbara ◽  
Feras Hawari ◽  
John Johnkoski
Keyword(s):  
Lung Cancer ◽  
Haemophilus Influenzae ◽  
Case Reports ◽  
Healthcare Providers ◽  
Community Acquired Pneumonia ◽  
The Other ◽  
Alveolar Haemorrhage ◽  
Diffuse Alveolar Haemorrhage ◽  
Life Saving ◽  
Intravenous Steroids

Diffuse alveolar haemorrhage (DAH) is known to occur from several infectious and non-infectious aetiologies. Among the infectious aetiologies, Haemophilus influenzae, an organism known to cause community-acquired pneumonia, has not been reported in association with DAH prior to this case. On the other hand, vaping, an evolving epidemic concern, has been linked to various types of lung injury, including DAH. However, DAH related to vaping is only limited to several case reports. Our case describes H. influenzae pneumonia with DAH in a patient known to have vaped until the night prior to elective lobectomy for lung cancer and developed DAH within 24 hours of hospitalisation. He subsequently recovered with treatment. DAH requires immediate recognition, and healthcare providers need to be aware that neither haemoptysis nor decrease in haemoglobin level is necessarily associated. Prior to diagnosis, empirical treatment with intravenous steroids and antibiotics can be life-saving.

Evaluation of clinicians’ knowledge, attitudes, and planned behaviors related to an intervention to improve acute respiratory infection management

2020 ◽  
Vol 41 (6) ◽  
pp. 672-679 ◽  
Author(s):  
Hayli R. Hruza ◽  
Tania Velasquez ◽  
Karl J. Madaras-Kelly ◽  
Katherine E. Fleming-Dutra ◽  
Matthew H. Samore ◽  
...  
Keyword(s):  
Communication Strategies ◽  
Implementation Strategies ◽  
Patient Communication ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Health Administration ◽  
Prescribing Practices ◽  
Diagnostic Uncertainty ◽  
Appropriate Prescribing ◽  
Tract Infections

AbstractBackground:Acute respiratory tract infections (ARIs) are commonly diagnosed and major drivers of antibiotic prescribing. Clinician-focused interventions can reduce unnecessary antibiotic prescribing for ARIs. We elicited clinician feedback to design sustainable interventions to improve ARI management by understanding the mental framework of clinicians surrounding antibiotic prescribing within Veterans’ Health Administration clinics.Methods:We conducted one-on-one interviews with clinicians (n = 20) from clinics targeted for intervention at 5 facilities. The theory of planned behavior guided interview questions. Interviews were audio recorded and transcribed for qualitative analysis. An iterative coding approach identified 6 themes.Results:Emergent themes: (1) barriers to appropriate prescribing are multifactorial and include challenges of behavior change; (2) antibiotic prescribing decisions are perceived as autonomous yet, diagnostic uncertainty and perceptions of patient demand can make prescribing decisions difficult; (3) clinicians perceive variation in peer prescribing practices and influences; (4) clinician-focused interventions are valuable if delivered with sensitivity; (5) communication strategies for educating patients are preferred to a shared decisions process; and (6) team standardization of practice and communication are key to facilitate appropriate prescribing. Clinicians perceived audit-and-feedback with peer comparison, academic detailing, and enhanced patient communication strategies as viable approaches to improving appropriate prescribing.Conclusion:Implementation strategies that enable clinicians to overcome diagnostic uncertainty, perceived patient demand, and improve patient education are desired. Implementation strategies were welcomed, and some were more readily accepted (eg, audit feedback) than others (eg, shared decision making). Implementation strategies should address clinicians’ perceptions of antibiotic prescribing practices and should enhance their patient communication skills.

scholarly journals 1143. Measuring Up! Benchmarking Antimicrobial Use in Canadian Children’s Hospitals

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S407-S407
Author(s):  
Julie Blackburn ◽  
Jennifer Bowes ◽  
Mary-Ann Harrison ◽  
Nick Barrowman ◽  
Hélène Roy ◽  
...  
Keyword(s):  
First Generation ◽  
Empiric Therapy ◽  
Community Acquired Pneumonia ◽  
Antimicrobial Use ◽  
Prescribing Practices ◽  
Cross Sectional ◽  
Pediatric Hospitals ◽  
The Mean ◽  
Abdominal Infections ◽  
Third Generation Cephalosporins

Abstract Background Inappropriate antimicrobial use (AU) is recognized as a leading cause of antimicrobial resistance. However, quantifying AU in hospitals is challenging due to variability in information systems. Point prevalence surveys (PPS) provide a means to quantify AU in a cross-sectional manner within and between institutions. The aim of the study was to describe and compare the prescription patterns of AU across pediatric hospitals in Canada using PPS. Methods Two PPS (November 2018 and February 2019) were conducted at each of the 15 Canadian pediatric hospitals. For each PPS, AU data were collected for all inpatients ≤ 18 years (excluded mental health and birthing units) on the survey date. Data, including admitting diagnosis, age, comorbidities, Infectious Diseases consult, admitting service, documented pathogen(s), and antimicrobial(s) prescribed, was collected and entered into a RedCap database. Results In total, we surveyed 3826 patient-days. The mean proportion of children receiving at least one antimicrobial was 35.2% [range 25.1% to 42.9%]. Of the 1951 antimicrobials prescribed, the most common were third-generation cephalosporins [3GC] (16%; 321), aminopenicillins (15%; 297), TMP-SMX (11%; 207), piperacillin–tazobactam (10%; 193) and first-generation cephalosporins (9%; 181). Overall, the frequency of carbapenems, quinolones and vancomycin use was 4% (79), 3% (65) and 8% (151), respectively. Of the antimicrobials used for targeted or empiric therapy (n = 1541), 373 (24.2%) were for pneumonia, 278 (18%) for intra-abdominal infections and 251 (16.3%) for fever without a source. For the treatment of community-acquired pneumonia (CAP) (n = 178), aminopenicillins and 3GC use was 31% and 37%, respectively. Conclusion Our study used a standardized approach to assess AU to obtain benchmarking data for Canadian pediatric hospitals. About one-third of children hospitalized in Canadian pediatric hospitals are prescribed at least one antimicrobial. Of patients on treatment for CAP, only 31% were prescribed aminopenicillins. More detailed analysis of the rationale for AU, and assessment of appropriateness is required to fully understand antimicrobial prescribing practices in pediatric hospitals and develop stewardship initiatives. Disclosures All authors: No reported disclosures.

scholarly journals Healthcare digital services in Italy: good practices across Regions

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
S Z Zuccarino ◽  
E G Guidotti ◽  
M C Cassano ◽  
S D R De Rosis ◽  
F F Ferrè
Keyword(s):  
Healthcare Providers ◽  
Digital Transformation ◽  
Teaching Hospitals ◽  
Public Healthcare ◽  
Local Health ◽  
Healthcare Organizations ◽  
Grid Data ◽  
Outpatient Visits ◽  
Digital Services ◽  
Health Authorities

Abstract Background In Europe, digital transformation of healthcare is one of the agenda priorities. Institutional websites and mobile applications (APPs) have been increasingly adopted by healthcare organizations for communication and service delivery. This study aims at describing the state of art and the variability of healthcare digitalization in Italy. Methods The study focuses on 144 active websites of public healthcare organizations (i.e. Local Health Authorities and Teaching Hospitals) of 11 out of the 21 Regional healthcare systems in Italy. The research investigates whether the healthcare organizations provide e-booking and e-paying for outpatient visits through their website/APP and whether citizens are informed of this opportunity. Researchers independently analyze the websites taking the user’s perspective, by adopting a common grid. Data refers to December 2018. Results The majority of items analyzed show a high variability within and among Regions. The provision of online services patients can benefit of change across the same territory. Almost 76% of the LHAs/hospitals allow for e-booking of outpatient visits and e-paying is available for 84% of them. The adoption of APPs for healthcare is not homogenous. Some Regions develop a specific regional tool (e.g. Apulia, Lombardy) providing uniform access to digital services to their resident population while in other Regions, public healthcare providers can implement their own APP (e.g. Liguria, Veneto). Conclusions Our findings suggest that centralizing digital services - at least at regional level - can enhance healthcare digitalization in Italy, avoiding jeopardized and unequal provision of digital services. Further research should investigate the actual use of these services by citizens and the reasons of variability. Key messages Italy is in delay in digital transformation of healthcare. Our study supports the identification of good regional practices, which could endorse the implementation of future actions.

Inappropriate opioid prescribing practices: A narrative review

2019 ◽  
Vol 76 (16) ◽  
pp. 1231-1237 ◽  
Author(s):  
Brian Kim ◽  
Seonaid Nolan ◽  
Tara Beaulieu ◽  
Stephen Shalansky ◽  
Lianping Ti
Keyword(s):  
Literature Review ◽  
Data Extraction ◽  
Inappropriate Prescribing ◽  
Healthcare Providers ◽  
Opioid Analgesics ◽  
Drug Misuse ◽  
Patient Specific ◽  
Prescribing Practices ◽  
Prescription Drug Misuse ◽  
Opioid Prescribing

Abstract Purpose Results of a literature review to identify indicators of inappropriate opioid prescribing are presented. Summary While prescription opioids can be effective for the treatment of acute pain, inappropriate prescribing practices can increase the risk of opioid-related harms, including overdose and mortality. To date, little research has been conducted to determine how best to define inappropriate opioid prescribing. Five electronic databases were searched to identify studies (published from database inception to January 2017) that defined inappropriate opioid prescribing practices. Search terms varied slightly across databases but included opioid, analgesics, inappropriate prescribing, practice patterns, and prescription drug misuse. Gray literature and references of published literature reviews were manually searched to identify additional relevant articles. From among the 4,665 identified articles, 41 studies were selected for data extraction and analysis. Fourteen studies identified high-daily-dose opioid prescriptions, 14 studies identified coadministration of benzodiazepines and opioids, 10 studies identified inappropriate opioid prescribing in geriatric populations, 8 studies identified other patient-specific factors, 4 studies identified opioid prescribing for the wrong indication, and 4 studies identified factors such as initiation of long-acting opioids in opioid-naive patients as indicators of inappropriate opioid prescribing. Conclusion A literature review identified various indicators of inappropriate opioid prescribing, including the prescribing of high daily doses of opioids, concurrent benzodiazepine administration, and geriatric-related indicators. Given the significant contribution of inappropriate opioid prescribing to opioid-related harms, identification of these criteria is important to inform and improve opioid prescribing practices among healthcare providers.

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