Van SP, Yao AL, Tang T, Kott M, Noles A, Dabai N, Coslick A, Rojhani S, Sprankle LA, Hoyer EH. Implementing an Opioid Risk Reduction Program in the Acute Comprehensive Inpatient Rehabilitation Setting.
Arch Phys Med Rehabil 2019;
100:1391-1399. [PMID:
31121153 DOI:
10.1016/j.apmr.2019.04.011]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE
To describe the implementation and evaluation of an interdisciplinary quality improvement (QI) project to increase prescription of take-home naloxone (THN) to reduce risks associated with opioids for patients admitted to an acute inpatient rehabilitation unit.
DESIGN
Prospective cohort quality improvement project.
SETTING
Eighteen-bed acute comprehensive inpatient rehabilitation (ACIR) unit at a large academic institution.
PARTICIPANTS
Patients admitted to ACIR between December 2015-November 2016 (N=788).
INTERVENTIONS
An interdisciplinary QI model comprised of planning, education, implementation, and maintenance was used to implement a THN and opioid risk-reduction program involving provider and patient education. Analyses consisted of comparisons between baseline, early, and late phases of the project.
MAIN OUTCOME MEASURES
(1) The proportion of eligible patients who received a prescription for naloxone upon discharge from ACIR; (2) the proportion of patients originally admitted to ACIR on opioids that were weaned off upon discharge.
RESULTS
The adjusted odds of eligible patients being discharged from ACIR with a naloxone prescription during the late QI period were 7 (95% confidence interval [CI]: 3-21) times higher than during the early QI period (late QI period: 43%, 95% CI: 25%-63%; early QI period: 10%, 95% CI: 3%-28%; P<.001). For patients admitted on opioids, the adjusted odds of being weaned off opioids during the late QI period were 10 (95% CI: 4-25) times higher than during baseline (late QI period: 29%, 95% CI: 17%-45%; baseline: 4%, 95% CI: 1%-10%; P<.001).
CONCLUSIONS
Implementation of a THN and opioid risk reduction QI project in an inpatient rehabilitation setting led to significantly more eligible patients receiving naloxone and more patients weaned off schedule II opioids.
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