• Emmeline C Academia, Christian J Gabriel, Amanda Mueller, Kerry A Schwarz, Karsten Bartels, Robert J Valuck, and Paul M Reynolds.
• University of Colorado Hospital, Aurora, CO, USA.
• Ann Pharmacother. 2020 Nov 1; 54 (11): 1065-1072.

BackgroundOpioids are utilized for pain management during and after mechanical ventilation in the intensive care unit (ICU).ObjectiveThe purpose of this study was to determine the percentage of potentially unnecessary opioid prescriptions on discharge in previously opioid-naïve patients.MethodsThis retrospective cohort study included mechanically ventilated, opioid-naïve ICU patients who received opioids. The primary outcome of this study was the discrepancy between the amounts of opioids prescribed at discharge versus those likely required based on actual 24-hour prehospital discharge opioid requirements.ResultsA total of 71 patients were included. Of these, 63.3% (n = 45) of discharge prescriptions were in alignment with 24-hour predischarge requirements, and 36.7% (n = 26) of discharge prescriptions were in excess of calculated predischarge requirements. At discharge, 57.7% (n = 41) of patients received a nonopioid analgesic. Multivariable linear regression revealed that cardiothoracic ICU admission was associated with an increased risk of inappropriate discharge opioid prescribing, whereas a shorter duration of inpatient oral opioid therapy decreased risk of inappropriate discharge prescribing.Conclusion And RelevanceOpioid prescribing for previously mechanically ventilated patients warrants improvement as a part of the discharge planning process. Application of these data may aid in the reduction of opioid overprescribing at discharge after an ICU stay.

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