Analgesics on discharge

- February 1, 2015

The discharge prescribing of opioid analgesics, particularly oxycodone, has caused concern nationally and locally. Canterbury District Health Board (CDHB) encourages the prescribing of morphine in preference to oxycodone in most situations. In New Zealand the number of community prescriptions for oxycodone increased 5-fold between 2006 and 2013. In CDHB this was accompanied by a slight dip in morphine prescribing between 2010 and 2011 before increasing again. It was thought by some that the increased prescribing of opioids and oxycodone in particular may have been from hospital discharges. An extensive study of analgesics on discharge was carried out to evaluate analgesics prescribed on discharge.

Aim

To describe the analgesics prescribed on discharge from Christchurch Hospital and Christchurch Women’s Hospital over the course of 10 days

Method

  • Data were collected on all patients discharged from Christchurch and Christchurch Women’s Hospitals (excluding Paediatric and Maternity services) over ten consecutive days in May 2014 using discharge records, discharge prescriptions and dispensing records of each patient in Health Connect South and eSCRV.
  • Data collected included demographics, speciality, discharging ward, analgesic prescribed and whether it had been initiated in hospital or not.

Results

  • Over the 10 day study period;
    • 3,234 patient discharge records were reviewed
    • 1,074 patients (33%) had analgesics prescribed
      • 555 (52%) were female
      • median (interquartile range) age was 48 (27-75) years.

Opioid prescribing

Codeine was the most commonly used opioid on discharge while oxycodone was the 4th most common:

No. of patients (% of all discharges)
codeine 478 (15%)
tramadol 135 (4%)
morphine 62 (2%)
oxycodone 24 (0.7%)
fentanyl 9 (0.3%)
methadone 4 (0.1%)

 

28 patients were prescribed two opioids on discharge in various combinations (see below). The use of the majority of these combinations does not make pharmacological sense.

Opioid combination No. of patients
morphine + codeine  8
morphine + tramadol  6
morphine + fentanyl 3
oxycodone + tramadol 2
oxycodone + codeine 1
fentanyl + tramadol 1
fentanyl + codeine  1
tramadol + codeine 6

Morphine or oxycodone

The following table shows the number of patients prescribed either of these opioids on discharge by speciality. The percentage of these initiated on the opioid in hospital is shown in brackets.

Specialty Patients discharged on morphine n=62

(% of these initiated in hospital)

Patients discharged on oxycodone n=24

(% of these initiated in hospital)

Oncology 15 (60%) 0 (0%)
General Medicine 9 (22%) 6 (50%)
Neurosurgery 6 (83%) 0 (0%)
Urology 6 (83%) 0 (0%)
General Surgery 5 (40%) 4 (100%)
Emergency 4 (75%) 0 (0%)
Haematology 3 (100%) 0 (0%)
Orthopaedics 3 (100%) 5 (80%)
Plastic Surgery 2 (50%) 1 (unknown)
Respiratory 2 (0%) 1 (100%)
Cardiology 1 (100%) 0 (0%)
Cardiothoracic 1 (100%) 2 (100%)
Gastroenterology 1 (0%) 1 (0%)
Nephrology 1 (100%) 0 (0%)
Ophthalmology 1 (100%) 0 (0%)
Otolaryngology 1 (0%) 1 (0%)
Vascular Surgery 1 (unknown) 1 (unknown)
Gynaecology 0 (0%) UBI

Note: 14 of the 24 patients prescribed oxycodone were initiated on it in hospital. Seven (50%) of these had had adverse reactions to morphine in the past.

Conclusions

In this study the most commonly prescribed analgesics on discharge were paracetamol, NSAIDs, codeine and tramadol. The prescribing of other opioids on discharge was minimal. Morphine was prescribed more frequently than oxycodone.

Download PDF