title: Multidisciplinary intervention decreases the use of opioid medication discharge packs from 2 urban EDs.
abstract: BACKGROUND
  Prescription opioid overdoses and deaths constitute a public health epidemic, and recent studies show that emergency department (ED) prescribers may contribute to this crisis. We hypothesized that a multidisciplinary educational intervention would decrease ED opioid packs dispensed at discharge.
  
  
  METHODS
  This prospective study implemented a "bundle" of interdisciplinary educational modalities: lectures, journal clubs, case discussions, and an electronic medical record decision support tool. Implementation occurred in 2 urban EDs in the same health system at different times ("affiliate," September 2011; "primary," January 2012) to better distinguish its effects. The primary outcome was preintervention/postintervention change in opioid discharge packs dispensed to all patients treated and discharged through August 2012 and was assessed by 2-way analysis of variance. The secondary outcome was bivariate analysis (using Fisher exact test) of change in opioid dispensing among patients with known risk factors for prescription opioid dependence: age less than 65 years, history of substance abuse, chronic pain, or psychiatric disorders.
  
  
  RESULTS
  A total of 71,512 and 45,746 patients were evaluated and discharged from primary and affiliate EDs, respectively. Orders for opioid discharge packs decreased from 13.9% to 8.4% and 4.7% to 1.9% at the primary and affiliate hospitals (P < .0001). Dispensing among individuals at risk for opioid dependence at the primary ED decreased from 21.8% to 13.9%.
  
  
  CONCLUSIONS
  A staged, multidisciplinary intervention targeting nurses, residents, nurse practitioners, and attending physicians was associated with decreased orders for opioid discharge packs in 2 urban EDs. Opioid discharge pack orders decreased slightly more among patients with risk factors for prescription opioid dependence.
authors.affiliation: Department of Emergency Medicine, Hospital of the University of Pennsylvania. Electronic address: hallamg@gmail.com.
authors.forename: Hallam
authors.initials: H
authors.lastname: Gugelmann
authors.forename: Frances S
authors.initials: FS
authors.lastname: Shofer
authors.forename: Zachary F
authors.initials: ZF
authors.lastname: Meisel
authors.forename: Jeanmarie
authors.initials: J
authors.lastname: Perrone
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D003661:Decision Support Techniques; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems / Q000458:organization & administration; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000517:prevention & control; D010348:Patient Care Team; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000701:Analgesics, Opioid