title: The Changing Use of Intravenous Opioids in an Emergency Department.
abstract: BACKGROUND
  Government agencies are increasingly emphasizing opioid safety in hospitals. In 2012, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) started a sentinel event program, the "Safe Use of Opioids in Hospitals." We sought to determine if opioid use patterns in our emergency department (ED) changed from 2011, before the program began, to 2013, after start of the program.
  
  
  METHODS
  This was a retrospective study of all adult ED patients who received an intravenous opioid and had a serum creatinine measured. We recorded opioids used, dose prescribed, and serum creatinine. As an index of the safety of opioids, uses of naloxone after administration of an opioid was recorded.
  
  
  RESULTS
  Morphine is still the most commonly used opioid by doses given, but its percentage of opioids used decreased from 68.9% in 2011 to 52.8% in 2013. During the same period, use of hydromorphone increased from 27.5% to 42.9%, while the use of fentanyl changed little (3.6% to 4.3%). Naloxone administration was rare after an opioid had been given. Opioids were not dosed in an equipotent manner.
  
  
  CONCLUSIONS
  The use of hydromorphone in our ED increased by 56% (absolute increase of 15.4%), while the use of morphine decreased by 30.5% (absolute decrease 16.1%) of total opioid use from 2011 to 2013. The JCAHO program likely was at least indirectly responsible for this change in relative dosing of the opioids. Based on frequency of naloxone administered after administration of an opioid, the use of opioids was safe.
authors.affiliation: University of California, Davis, Department of Emergency Medicine, Division of Medical Toxicology, Sacramento, California; VA Northern California Health Care System, Mather, California.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Sutter
authors.affiliation: University of California, Davis, Department of Emergency Medicine, Sacramento, California.
authors.forename: Garen J
authors.initials: GJ
authors.lastname: Wintemute
authors.affiliation: University of California, Davis, Department of Emergency Medicine, Sacramento, California.
authors.forename: Samuel O
authors.initials: SO
authors.lastname: Clarke
authors.affiliation: University of California, Davis, Department of Emergency Medicine, Division of Medical Toxicology, Sacramento, California; VA Northern California Health Care System, Mather, California.
authors.forename: Bailey M
authors.initials: BM
authors.lastname: Roche
authors.affiliation: University of California, Davis, Department of Emergency Medicine, Division of Medical Toxicology, Sacramento, California; VA Northern California Health Care System, Mather, California.
authors.forename: James A
authors.initials: JA
authors.lastname: Chenoweth
authors.affiliation: University of California, Davis, Department of Pharmacy, Sacramento, California.
authors.forename: Rory
authors.initials: R
authors.lastname: Gutierrez
authors.affiliation: University of California, Davis, Department of Emergency Medicine, Division of Medical Toxicology, Sacramento, California; VA Northern California Health Care System, Mather, California; University of California, Davis, Department of Internal Medicine, Sacramento, California.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Albertson
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D004363:Drug Utilization / Q000639:trends*; D004636:Emergency Service, Hospital / Q000639:trends*; D004638:Emergency Treatment / Q000639:trends*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009270:Naloxone / Q000008:administration & dosage; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data
chemical_list: D000701:Analgesics, Opioid; D009270:Naloxone; D009020:Morphine; D004091:Hydromorphone; D005283:Fentanyl