Discharge prescribing of enteral opioids after initiation as a weaning strategy from continuous opioid infusions in the Intensive Care Unit

Bridgette Kram, PharmD, BCPS, BCCCP; Kylie M. Weigel, PharmD, BCPS; Michelle Kuhrt, PharmD; Daniel L. Gilstrap, MD

doi:10.5055/jom.2018.0427

Authors

Bridgette Kram, PharmD, BCPS, BCCCP
Kylie M. Weigel, PharmD, BCPS
Michelle Kuhrt, PharmD
Daniel L. Gilstrap, MD

DOI:

https://doi.org/10.5055/jom.2018.0427

Keywords:

transitions of care, medication reconciliation, methadone, critical care, pain

Abstract

Objective: To evaluate the proportion of patients receiving a hospital discharge prescription for a scheduled enteral opioid following initiation as a weaning strategy from a continuous opioid infusion in the Intensive Care Unit (ICU).

Design: Retrospective, observational study.

Setting: Five adult ICUs at a large, quaternary care academic medical center.

Patients: Endotracheally intubated, opioid-naive adults receiving a continuous opioid infusion with a concomitant scheduled enteral opioid initiated. Exclusion criteria were receipt of fewer than two enteral opioid doses, documentation of a long-acting opioid as a home medication, the indication for the enteral opioid was not a weaning strategy, death during hospital admission or discharge to hospice.

Interventions: None.

Main outcome measures: The proportion of ICU and hospital survivors who received a discharge prescription for a scheduled enteral opioid, total duration of continuous opioid infusion, duration of continuous opioid infusion after initiation of an enteral opioid therapy, total duration of enteral therapy, ICU and hospital length of stay.

Results: Of 62 included patients, 19 patients (30.6 percent) received a new prescription for a scheduled enteral opioid at hospital discharge. The median duration of enteral opioid therapy was longer for patients who received a discharge prescription compared to those who did not (20.09 vs 8.89 days, p = 0.02), though the remaining endpoints were not different.

Conclusions: Utilizing scheduled enteral opioids as a weaning strategy from continuous opioid infusions may place patients at risk of ICU-acquired physical dependence on opioids.

Author Biographies

Bridgette Kram, PharmD, BCPS, BCCCP

Clinical Pharmacist, Department of Pharmacy, Duke University Hospital, Durham, North Carolina

Kylie M. Weigel, PharmD, BCPS

Clinical Pharmacist, Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts

Michelle Kuhrt, PharmD

Clinical Pharmacist, Department of Pharmacy, Duke University Hospital, Durham, North Carolina

Daniel L. Gilstrap, MD

Division of Pulmonology, Allergy, and Critical Care Medicine, Duke University Hospital, Durham, North Carolina

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