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Emergency department opioid discharge instructions: a multidisciplinary national Delphi study

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Abstract

Objectives

Currently, there are no Canadian guidelines for discharge instruction to be given to patients receiving an opioid prescription in the ED. This likely contributes to inadequate discharge instructions for these potentially dangerous medications. The principal goal of this study was to develop an interdisciplinary Canadian consensus regarding important concepts to be included in written opioid discharge instructions within the ED setting.

Methods

We conducted a modified Delphi study between May and August 2021. The national multidisciplinary panel consisted of 23 healthcare professionals and one patient partner. The survey consisted of 19 initial concepts developed after a review of the literature and a meeting with local experts. The panel added four new concepts after the first survey round. Three rounds of online surveys were distributed in total. Panel consensus was defined a priori as a disagreement index score less than 1, in accordance with the RAND/UCLA Appropriateness Method.

Results

We achieved a 100% response rate in round one and a 96% response rate in rounds two and three of our Delphi study. There was group consensus (disagreement index = 0.66, median importance = 9) that all patients receiving opioid prescriptions from the ED should receive written discharge instructions. The interdisciplinary panel arrived at a consensus on 21/23 concepts for ED opioid discharge instructions. The concepts with the highest level of agreement were related to minimizing the use of the prescribed opioid medication and opioid use safety (mixing with drugs/alcohol, storage, and impairment).

Conclusion

This Delphi study with a national, multidisciplinary panel achieved consensus on 21 concepts that should be included in written discharge instructions to patients receiving an opioid prescription upon discharge from the ED.

Résumé

Objectifs

Actuellement, il n’y a pas de lignes directrices canadiennes sur les instructions de sortie à donner aux patients qui reçoivent une ordonnance d'opioïdes aux urgences. Cela contribue probablement à des instructions de sortie inadéquates pour ces médicaments potentiellement dangereux. L’objectif principal de cette étude était d’établir un consensus canadien interdisciplinaire sur les concepts importants à inclure dans les directives écrites de sortie des opioïdes dans le contexte des urgences.

Méthodes

Nous avons mené une étude Delphi modifiée entre mai et août 2021. Le comité national multidisciplinaire était composé de 23 professionnels de la santé et d’un patient partenaire. L’enquête comprenait 19 concepts initiaux développés après un examen de la littérature et une réunion avec des experts locaux. Le panel a ajouté quatre nouveaux concepts après la première ronde d’enquête. Trois séries de sondages en ligne ont été distribuées au total. Le consensus du panel a été défini a priori comme un indice de désaccord inférieur à 1, conformément à la méthode de pertinence RAND/UCLA.

Résultats

Nous avons atteint un taux de réponse de 100 % au premier tour et un taux de réponse de 96 % aux deuxième et troisième tours de notre étude Delphi. Il y avait un consensus de groupe (indice de désaccord = 0,66, importance médiane = 9) sur le fait que tous les patients recevant une ordonnance d'opioïdes aux urgences devraient recevoir des instructions écrites à la sortie de l'hôpital. Le groupe interdisciplinaire est parvenu à un consensus sur les concepts 21/23 pour les instructions de sortie d’opioïdes aux urgences. Les concepts ayant fait l’objet du plus haut niveau d’entente étaient liés à la réduction de l’utilisation des médicaments opioïdes prescrits et à la sécurité de l’utilisation des opioïdes (mélange avec les drogues/alcool, stockage et affaiblissement des facultés).

Conclusion

Cette étude Delphi avec un panel national multidisciplinaire a permis de parvenir à un consensus sur 21 concepts qui devraient être inclus dans les instructions écrites de sortie aux patients recevant une ordonnance d’opioïdes à leur sortie de l’urgence.

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Acknowledgements

We thank Angela Marcantonio for her assistance with this project. Karine Fournier was invaluable to completing the literature review. We would also like to thank the panellists who completed the Delphi Survey, especially our patient partners.

Funding

This project received no funding.

Author information

Authors and Affiliations

  1. The University of Ottawa, Ottawa, ON, Canada

    Nathaniel M. Murray, Krishan Yadav, Daniel James, Avik Nath, Roland Halil, Moaweya Zayed & Debra Eagles

  2. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Krishan Yadav & Debra Eagles

  3. Universite de Montreal, Montreal, QC, Canada

    Raoul Daoust

  4. CIUSSS Nord-de-L’ile, Ottawa, ON, Canada

    Raoul Daoust

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  1. Nathaniel M. Murray
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Contributions

NMM, KY, RD and DE conceived the idea, were responsible for study design, survey development, data collection and analysis. DJ, AN, RH, and MZ were also responsible for survey development. All authors contributed to the interpretation of study results and the completion of the manuscript. NMM takes responsibility for the project as a whole.

Corresponding author

Correspondence to Nathaniel M. Murray.

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Murray, N.M., Yadav, K., Daoust, R. et al. Emergency department opioid discharge instructions: a multidisciplinary national Delphi study. Can J Emerg Med 24, 641–649 (2022). https://doi.org/10.1007/s43678-022-00352-7

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