title: Development of an opioid reduction protocol in an emergency department.
abstract: OBJECTIVE
  Results of a study of an opioid-sparing protocol for acute pain management in the emergency department (ED) are reported.
  
  
  METHODS
  The ED of a large hospital conducted a project, the "Opioid-Free Shift," to test a multimodal pharmacologic approach to analgesic therapy as an alternative to routine use of opioids. During a specified eight-hour period, all adults arriving at the ED with a complaint of pain were treated according to an opioid-sparing protocol based on principles of channel enzyme receptor-targeted analgesia (CERTA). Pain severity was assessed at baseline and at 30 and 60 minutes after analgesia administration using a validated rating scale.
  
  
  RESULTS
  Seventeen patients were treated in the ED for acute or chronic pain during the study period. The median pain score on the 11-point rating scale was 8 (range, 4-10) at baseline, declining to 6 (range, 0-10) at 30 minutes and to 5 (range, 1-10) at 60 minutes. At 30 minutes, 7 patients (41%) had a pain score reduction of ≥ 30% and 3 (18%) had a reduction of ≥ 50%. Six of the 15 patients (40%) reassessed at 60 minutes had a pain score reduction of ≥ 30%; 4 patients (27%) had a reduction of ≥ 50%. More than 80% of patients were satisfied with the pain relief provided through the CERTA-based protocol, and no adverse drug reactions were reported.
  
  
  CONCLUSIONS
  The 17 patients treated for acute or chronic pain during the opioid-free shift were managed mainly with i.v. ketorolac and oral ibuprofen, with only 1 patient requiring rescue opioid therapy.
authors.affiliation: Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center. vcohen@maimonidesmed.org.
authors.forename: Victor
authors.initials: V
authors.lastname: Cohen
authors.affiliation: Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center.
authors.forename: Sergey
authors.initials: S
authors.lastname: Motov
authors.affiliation: Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center.
authors.forename: Bradley
authors.initials: B
authors.lastname: Rockoff
authors.affiliation: Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center.
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.affiliation: Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center.
authors.forename: Christian
authors.initials: C
authors.lastname: Fromm
authors.affiliation: Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Bosoy
authors.affiliation: Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center.
authors.forename: Rukhsana
authors.initials: R
authors.lastname: Hossain
authors.affiliation: Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center.
authors.forename: Antonios
authors.initials: A
authors.lastname: Likourezos
authors.affiliation: Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center.
authors.forename: Samantha P
authors.initials: SP
authors.lastname: Jellinek-Cohen
authors.affiliation: Victor Cohen, Pharm.D., BCPS, CGP, is Corporate Clinical Director of Pharmacy Services (Assistant Vice President), Health and Hospital Corporation of New York City, New York, NY; at the time of writing, he was Associate Professor of Pharmacy Practice, Long Island University (LIU) Arnold & Marie Schwartz College of Pharmacy and Health Sciences, and Clinical Pharmacy Manager of Emergency Medicine, Pharmacy Residency Program Director, Postgraduate Year 1 Pharmacy and Postgraduate Year 2 (PGY2) Emergency Medicine Pharmacy Residency Programs, Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY. Sergey Motov, M.D., is Assistant Program Director, Department of Emergency Medicine; and Bradley Rockoff, M.D., is Research Fellow, Department of Emergency Medicine, Maimonides Medical Center. Andrew Smith, Pharm.D., BCPS, is PGY2 Emergency Medicine Pharmacy Resident, Maimonides Medical Center, and Clinical Instructor of Pharmacy Practice, LIU Arnold & Marie Schwartz College of Pharmacy and Health Sciences. Christian Fromm, M.D., is Director of Emergency Medicine Research, Department of Emergency Medicine; Dimitri Bosoy, M.D., is Emergency Medicine Attending, Department of Emergency Medicine; Rukhsana Hossain, M.P.H., is Research Assistant, Department of Emergency Medicine; and Antonios Likourezos, M.A., M.P.H., is Research Manager, Department of Emergency Medicine, Maimonides Medical Center. Samantha P. Jellinek-Cohen, Pharm.D., BCPS, CGP, is Assistant Clinical Professor, Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, and Emergency Medicine Clinical Pharmacy Specialist, Mount Sinai Beth Israel, New York. John Marshall, M.D., is Chair of Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center.
authors.forename: John
authors.initials: J
authors.lastname: Marshall
mesh_terms: D059787:Acute Pain / Q000188:drug therapy*; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D059350:Chronic Pain / Q000188:drug therapy; D004636:Emergency Service, Hospital; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage; D020910:Ketorolac / Q000008:administration & dosage; D010147:Pain Measurement; D017060:Patient Satisfaction; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D007052:Ibuprofen; D020910:Ketorolac