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{
    "pk": 9295,
    "title": "The Changing Use of Intravenous Opioids in an Emergency Department",
    "subtitle": null,
    "abstract": "Introduction: \nGovernment 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.\nMethods: \nThis 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.\nResults: \nMorphine 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.\nConclusion: \nThe 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.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Opioids, Medication Safety"
        }
    ],
    "section": "Societal Impact on Emergency Care",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/4z62r7x7",
    "frozenauthors": [
        {
            "first_name": "Mark",
            "middle_name": "E.",
            "last_name": "Sutter",
            "name_suffix": "",
            "institution": "University of California, Davis, Department of Emergency Medicine, Division of Medical Toxicology, Sacramento, California; VA Northern California Health Care System, Mather, California",
            "department": "None"
        },
        {
            "first_name": "Garen",
            "middle_name": "J.",
            "last_name": "Wintemute",
            "name_suffix": "",
            "institution": "University of California, Davis, Department of Emergency Medicine, Sacramento, California",
            "department": "None"
        },
        {
            "first_name": "Samuel",
            "middle_name": "O.",
            "last_name": "Clarke",
            "name_suffix": "",
            "institution": "University of California, Davis, Department of Emergency Medicine, Sacramento, California",
            "department": "None"
        },
        {
            "first_name": "Bailey",
            "middle_name": "M.",
            "last_name": "Roche",
            "name_suffix": "",
            "institution": "University of California, Davis, Department of Emergency Medicine, Division of Medical Toxicology, Sacramento, California; VA Northern California Health Care System, Mather, California",
            "department": "None"
        },
        {
            "first_name": "James",
            "middle_name": "A.",
            "last_name": "Chenoweth",
            "name_suffix": "",
            "institution": "University of California, Davis, Department of Emergency Medicine, Division of Medical Toxicology, Sacramento, California; VA Northern California Health Care System, Mather, California",
            "department": "None"
        },
        {
            "first_name": "Rory",
            "middle_name": "",
            "last_name": "Gutierrez",
            "name_suffix": "",
            "institution": "University of California, Davis, Department of Pharmacy",
            "department": "None"
        },
        {
            "first_name": "Timothy",
            "middle_name": "E.",
            "last_name": "Albertson",
            "name_suffix": "",
            "institution": "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",
            "department": "None"
        }
    ],
    "date_submitted": "2015-08-16T22:33:27Z",
    "date_accepted": "2015-08-16T22:33:27Z",
    "date_published": "2015-12-14T21:54:58Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/9295/galley/5247/download/"
        }
    ]
}