In hospital settings, continuous opioid infusions are frequently used to treat end-of-life (EOL) symptoms. Nevertheless, prescription procedures differ, and even contemporary research offers contradictory protocols and best practice standards. For a study, researchers sought to find out how frequently opioid infusions for comfort care at end-of-life are used at an academic medical institution and see if improper usage is linked to discomfort.
They identified 3 criteria for “possibly inappropriate” infusion usage through a literature study and iterative, multidisciplinary debate. They conducted a retrospective, observational study of inpatients who passed away over a period of six months, abstracting data from the electronic medical record regarding demographics, opioid use patterns, survival time, involvement of palliative care (PC), and indications of patient/caregiver/staff distress.
In the study, 193 deceased people who had opioid infusions for end-of-life comfort care were identified. The classification of 44% of the opioid infusions was “possibly inappropriate.” The most often occurring issues were the insufficient use of as-needed intravenous opioid boluses and the use of opioid infusions in patients who had never had them. Potentially inappropriate infusions were less likely when PC offered drug recommendations (20% vs. 50%; P<0.001) and were more frequently linked with a patient (24% vs. 2%; P<0.001) and staff distress (10% vs. 2%; P=0.02) distress.
At the hospital, an academic medical center with a functioning PC team, and current contracts for in-hospital hospice care, potentially inappropriate opioid infusions are common. Additionally, it has been shown that potentially unnecessary opioid infusions make patients and staff more distressed. Therefore, to address this safety concern, they were proposing an interdisciplinary intervention.