Evaluation of a hospital-based opioid stewardship program on high-risk opioid prescribing in a Canadian setting: an interrupted time series analysis
Abstract Background High-risk opioid prescribing (e.g., high daily dose opioids, concurrent opioid-sedatives) is prevalent in hospitals and linked to adverse outcomes. Opioid stewardship programs (OSP) have the potential to reduce high-risk opioid prescribing through audit-and-feedback recommendatio...
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BMC
2025-06-01
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| Series: | Addiction Science & Clinical Practice |
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| Online Access: | https://doi.org/10.1186/s13722-025-00574-x |
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| author | Lianping Ti Tamara Mihic Arielle Beauchesne Cameron Grant Ingrid Frank Nooreen Haji Michael Legal Stephen Shalansky Seonaid Nolan |
| author_facet | Lianping Ti Tamara Mihic Arielle Beauchesne Cameron Grant Ingrid Frank Nooreen Haji Michael Legal Stephen Shalansky Seonaid Nolan |
| author_sort | Lianping Ti |
| collection | DOAJ |
| description | Abstract Background High-risk opioid prescribing (e.g., high daily dose opioids, concurrent opioid-sedatives) is prevalent in hospitals and linked to adverse outcomes. Opioid stewardship programs (OSP) have the potential to reduce high-risk opioid prescribing through audit-and-feedback recommendations. Methods We evaluated an audit-and-feedback based OSP implemented in January 2020 at a Vancouver, Canada tertiary care hospital using interrupted time series analysis. An electronic health record (EHR) system with computerized provider order entry (CPOE) was simultaneously operationalized. The main outcome was: any high-risk opioid prescribing (based on 10 evidence-based indicators), including high daily dose of morphine milligram equivalent (MME) prescribing (> 90MME), long opioid prescription duration (> 5 days post-admission), and concurrent opioid-sedative prescribing. Results Between January 2018 and March 2022, 5,477 active opioid patient encounters were included. While no significant change occurred in overall high-risk opioid prescribing post-OSP (p > 0.05), a significant reduction was seen in the level of high daily dose of MME prescriptions (estimate: -0.044; 95% confidence interval [CI]: -0.082, -0.006). Conversely, the trend in long opioid duration increased (estimate: 0.006; 95%CI: 0.000, 0.011), likely due to the removal of automatic stop dates with the implementation of the EHR with CPOE. Post-OSP intervention, we initially saw an acute increase in concurrent opioid-sedative prescriptions (estimate: 0.013; 95%CI: 0.005, 0.020). A benzodiazepine ordering intervention implemented in May 2021 reversed this trend, reducing both the level (estimate: 0.874; 95%CI: 0.374, 1.375) and slope (estimate: -0.022, 95%CI: -0.034, -0.011) of concurrent prescriptions. Conclusion The implementation of a new EHR concordant with that of the OSP may have impacted our study’s results. While our research suggests the OSP reduced high-dose opioid prescribing, other indicators impacted by the EHR system did not benefit as highly from the OSP. Nevertheless, the OSP proved able to rapidly respond to unintended consequences by introducing interventions to reduce concurrent opioid and sedative prescribing. |
| format | Article |
| id | doaj-art-2d78fda2df5c48919ad6d5dc779a04aa |
| institution | OA Journals |
| issn | 1940-0640 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj-art-2d78fda2df5c48919ad6d5dc779a04aa2025-08-20T02:05:42ZengBMCAddiction Science & Clinical Practice1940-06402025-06-0120111010.1186/s13722-025-00574-xEvaluation of a hospital-based opioid stewardship program on high-risk opioid prescribing in a Canadian setting: an interrupted time series analysisLianping Ti0Tamara Mihic1Arielle Beauchesne2Cameron Grant3Ingrid Frank4Nooreen Haji5Michael Legal6Stephen Shalansky7Seonaid Nolan8British Columbia Centre on Substance UseBritish Columbia Centre on Substance UsePharmacy Department, Providence Health CareBritish Columbia Centre on Substance UseFaculty of Pharmaceutical Sciences, University of British ColumbiaFaculty of Pharmaceutical Sciences, University of British ColumbiaFaculty of Pharmaceutical Sciences, University of British ColumbiaFaculty of Pharmaceutical Sciences, University of British ColumbiaBritish Columbia Centre on Substance UseAbstract Background High-risk opioid prescribing (e.g., high daily dose opioids, concurrent opioid-sedatives) is prevalent in hospitals and linked to adverse outcomes. Opioid stewardship programs (OSP) have the potential to reduce high-risk opioid prescribing through audit-and-feedback recommendations. Methods We evaluated an audit-and-feedback based OSP implemented in January 2020 at a Vancouver, Canada tertiary care hospital using interrupted time series analysis. An electronic health record (EHR) system with computerized provider order entry (CPOE) was simultaneously operationalized. The main outcome was: any high-risk opioid prescribing (based on 10 evidence-based indicators), including high daily dose of morphine milligram equivalent (MME) prescribing (> 90MME), long opioid prescription duration (> 5 days post-admission), and concurrent opioid-sedative prescribing. Results Between January 2018 and March 2022, 5,477 active opioid patient encounters were included. While no significant change occurred in overall high-risk opioid prescribing post-OSP (p > 0.05), a significant reduction was seen in the level of high daily dose of MME prescriptions (estimate: -0.044; 95% confidence interval [CI]: -0.082, -0.006). Conversely, the trend in long opioid duration increased (estimate: 0.006; 95%CI: 0.000, 0.011), likely due to the removal of automatic stop dates with the implementation of the EHR with CPOE. Post-OSP intervention, we initially saw an acute increase in concurrent opioid-sedative prescriptions (estimate: 0.013; 95%CI: 0.005, 0.020). A benzodiazepine ordering intervention implemented in May 2021 reversed this trend, reducing both the level (estimate: 0.874; 95%CI: 0.374, 1.375) and slope (estimate: -0.022, 95%CI: -0.034, -0.011) of concurrent prescriptions. Conclusion The implementation of a new EHR concordant with that of the OSP may have impacted our study’s results. While our research suggests the OSP reduced high-dose opioid prescribing, other indicators impacted by the EHR system did not benefit as highly from the OSP. Nevertheless, the OSP proved able to rapidly respond to unintended consequences by introducing interventions to reduce concurrent opioid and sedative prescribing.https://doi.org/10.1186/s13722-025-00574-xOpioid stewardship programEvaluationHospitalHigh-risk prescribing |
| spellingShingle | Lianping Ti Tamara Mihic Arielle Beauchesne Cameron Grant Ingrid Frank Nooreen Haji Michael Legal Stephen Shalansky Seonaid Nolan Evaluation of a hospital-based opioid stewardship program on high-risk opioid prescribing in a Canadian setting: an interrupted time series analysis Addiction Science & Clinical Practice Opioid stewardship program Evaluation Hospital High-risk prescribing |
| title | Evaluation of a hospital-based opioid stewardship program on high-risk opioid prescribing in a Canadian setting: an interrupted time series analysis |
| title_full | Evaluation of a hospital-based opioid stewardship program on high-risk opioid prescribing in a Canadian setting: an interrupted time series analysis |
| title_fullStr | Evaluation of a hospital-based opioid stewardship program on high-risk opioid prescribing in a Canadian setting: an interrupted time series analysis |
| title_full_unstemmed | Evaluation of a hospital-based opioid stewardship program on high-risk opioid prescribing in a Canadian setting: an interrupted time series analysis |
| title_short | Evaluation of a hospital-based opioid stewardship program on high-risk opioid prescribing in a Canadian setting: an interrupted time series analysis |
| title_sort | evaluation of a hospital based opioid stewardship program on high risk opioid prescribing in a canadian setting an interrupted time series analysis |
| topic | Opioid stewardship program Evaluation Hospital High-risk prescribing |
| url | https://doi.org/10.1186/s13722-025-00574-x |
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