Kaitlin Landolf, BCCCP, PharmD
Critical Care Clinical Pharmacy Specialist
University of Maryland Medical Center
Baltimore, MD
Disclosure information not submitted.
Judy Noh
Doctorate of Pharmacy Candidate
University of Maryland School of Pharmacy, United States
Disclosure information not submitted.
Sandeep Devabhakthuni, PharmD, BCPS, BCCP
Assistant Professor; Clinical Pharmacy Specialist Cardiology/Critical Care
University of Maryland School of Medicine, United States
Disclosure information not submitted.
Mojdeh Heavner, BCCCP, BCPS, PharmD
Associate Professor and Vice Chair for Clinical Services
University of Maryland School of Pharmacy
Baltimore, MD
Disclosure information not submitted.
Title: Comparison of Patients Continued on Opioid Therapy Initiated in the ICU versus those not Continued
Introduction: Prescription of opioid therapy upon hospital discharge may pre-dispose patients to increased ED visits, hospital readmission or death. Continuation of opioid therapy in opioid naïve patients from the ICU across transitions of care has been previously described. However, characteristics of patients more likely to be continued on opioid therapy from the ICU are not well known. The aim of this study was to compare characteristics of opioid naïve patients with opioid therapy started in the ICU continued upon hospital discharge to those not continued on opioid therapy.
Methods: Medical charts of adult patients receiving scheduled or as needed enteral opioid therapy in the ICU during one week in February 2021 were reviewed for inclusion in this observational, retrospective chart review. Exclusion criteria included chronic opioid use prior to admission, epidural pain management, pain management by palliative or pain services, transition to comfort care/hospice and death prior to hospital discharge. Data collected include patient demographics, comorbidities, and characteristics of opioid regimens.
Results: A total of 57 opioid naive patients met criteria for inclusion with 25 (43.9%) opioid naïve patients continued on opioid therapy started in the ICU upon hospital discharge vs 32 (56.1%) patients not continued on opioid therapy. Patients meeting inclusion criteria had a median age of 52 (33-59) and Charlson Comorbidity Index of 2 (0-3). Median ICU length of stay was 20 (12-31) days and hospital length of stay was 29 (16-55) days. All patients in both groups received enteral oxycodone in the ICU. Continuous infusion opioids were administered to 22 (68.8%) of patients not continued on opioids and 24 (96%) of patients continued on opioids upon hospital discharge, p=0.79. Patients requiring mechanical ventilation included 29 (90.6%) of those not continued on opioids vs 24 (96%) continued on opioids, p=0.43.
Conclusions: In this hypothesis generating study there were no appreciable differences between patients started on opioid therapy in the ICU and continued upon discharge from the hospital compared to those not continued. Identification of potential risk factors for opioid continuation upon transitions of care may further improve opioid stewardship efforts.