Restriction of oxycodone in the emergency department (ROXY-ED): A randomised controlled trial.

IF 1.3 Q4 CLINICAL NEUROLOGY British Journal of Pain Pub Date : 2023-10-01 Epub Date: 2023-07-12 DOI:10.1177/20494637231189031
Biswadev Mitra, Cristina Roman, Bertha Wu, Carl Luckhoff, Diana Goubrial, Timothy Amos, Holly Bannon-Murphy, Ronald Huynh, Michael Dooley, De Villiers Smit, Peter A Cameron
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引用次数: 1

Abstract

Background: The prescription of opioids in emergency care has been associated with harm, including overdose and dependence. The aim of this trial was to assess restriction of access to oxycodone (ROXY), in combination with education and guideline modifications, versus education and guideline modifications alone (standard care) to reduce oxycodone administration in the Emergency Department (ED).

Methods: An unblinded, active control, randomised controlled trial was conducted in an adult tertiary ED. Participants were patients aged 18-75 years who had analgesics administered in the ED. The primary intervention was ROXY, through removal of all oxycodone immediate release tablets from the ED imprest, with availability of a small supply after senior clinician approval. The intervention did not restrict prescription of discharge medications. The primary outcome measure was oxycodone administration rates. Secondary outcomes were administration rates of other analgesic medications, time to initial analgesics and oxycodone prescription on discharge.

Results: There were 2258 patients eligible for analysis. Oxycodone was administered to 80 (6.1%) patients in the ROXY group and 221 (23.3%) patients in the standard care group (relative risk (RR) 0.26; 95% CI: 0.21 to 0.33; p < .001). Tapentadol was prescribed more frequently in the ROXY group (RR 2.17; 95% CI: 1.71-2.74), while there were no differences in prescription of other analgesic medications. On discharge, significantly fewer patients were prescribed oxycodone (RR 0.51; 95% CI: 0.39-0.66) and no differences were observed in prescription rates of other analgesic medications. There was no difference in time to first analgesic (HR 0.94; 95% CI: 0.86-1.02).

Conclusions: Restricted access to oxycodone was superior to education and guideline modifications alone for reducing oxycodone use in the ED and reducing discharge prescriptions of oxycodone from the ED. The addition of simple restrictive interventions is recommended to enable rapid changes to clinician behaviour to reduce the potential harm associated with the prescribing of oxycodone in the ED.

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羟考酮在急诊科的应用限制(ROXY-ED):一项随机对照试验
背景阿片类药物在急救中的处方与危害有关,包括过量用药和依赖性。本试验的目的是评估结合教育和指导方针修改获得羟考酮(ROXY)的限制,与单独教育和指导原则修改(标准护理)相比,以减少急诊科(ED)的羟考酮给药。方法在一名成人三级ED中进行一项非盲、主动对照、随机对照试验。参与者为年龄在18-75岁之间的患者,他们在ED中服用了止痛药。主要干预措施是ROXY,通过从ED缓冲液中取出所有羟考酮速释片,并在高级临床医生批准后提供少量供应。干预措施并未限制出院药物的处方。主要的疗效指标是羟考酮给药率。次要结果是其他镇痛药物的给药率、首次使用镇痛药的时间和出院时的羟考酮处方。结果2258例患者符合分析条件。ROXY组的80名(6.1%)患者和标准护理组的221名(23.3%)患者服用了羟考酮(相对风险(RR)0.26;95%置信区间:0.21至0.33;p<.001)。ROXY组更频繁地开具他喷他多的处方(RR 2.17;95%CI:1.71-2.74),而其他镇痛药物的处方没有差异。出院时,服用羟考酮的患者明显减少(RR 0.51;95%CI:0.39-0.66),其他镇痛药物的处方率没有差异。首次镇痛的时间没有差异(HR 0.94;95%CI:0.86–1.02)。结论限制使用羟考酮比单独修改教育和指南更能减少ED中羟考酮的使用和减少ED的羟考酮出院处方。建议增加简单的限制性干预措施,以使临床医生的行为能够迅速改变,从而减少与在ED中开羟考酮相关的潜在危害。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
British Journal of Pain
British Journal of Pain CLINICAL NEUROLOGY-
CiteScore
3.20
自引率
11.10%
发文量
42
期刊介绍: British Journal of Pain is a peer-reviewed quarterly British journal with an international multidisciplinary Editorial Board. The journal publishes original research and reviews on all major aspects of pain and pain management. Reviews reflect the body of evidence of the topic and are suitable for a multidisciplinary readership. Where empirical evidence is lacking, the reviews reflect the generally held opinions of experts in the field. The Journal has broadened its scope and has become a forum for publishing primary research together with brief reports related to pain and pain interventions. Submissions from all over the world have been published and are welcome. Official journal of the British Pain Society.
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