Article Figures & Tables
Figures
- Figure 1:
Prescriber distribution of total morphine equivalents prescribed per hour worked (A) and per patient seen (B). Error bars represent standard deviation; × represents mean. Note: MME = morphine milligram equivalent.
- Figure 2:
Cases of opioid overdose, overdose from high-risk or unknown substances, and opioid misuse presenting to the 3 emergency departments (EDs) in the Saskatoon Health Region from January 2016 to May 2018, along with deaths from opioid overdose. Vertical dashed line denotes implementation of ED guideline for prescribing of restricted medications. *Tcodes and F11. †Includes deaths occurring in hospital only. ‡Canadian Triage and Acuity Scale levels 1–3.
Tables
Characteristic No. (%) of physicians*
n = 32Gender Male 25 (78) Female 7 (22) Certification CCFP 8 (25) CCFP-EM 18 (56) FRCPC-EM 4 (12) Other 2 (6) Average years in practice (range) 12.66 (0 to 40) Average no. of patients seen (range) Before guideline implementation† 980.2 (244 to 2145) After guideline implementation‡ 912.7 (136 to 2272) Average hours worked (range) Before guideline implementation† 536.33 (136.00 to 966.50) After guideline implementation‡ 494.26 (87.25 to 993.25) Average no. of patients per hour (range) Before guideline implementation† 1.84 (1.12 to 2.46) After guideline implementation‡ 1.84 (1.45 to 2.29) Note: CCFP = Canadian College of Family Physicians, CCFP-EM = Canadian College of Family Physicians Emergency Medicine Certification, FRCPC-EM = Fellow of the Royal College of Physicians of Canada in Emergency Medicine.
↵* Unless stated otherwise.
↵† Nov. 1, 2015, to Apr. 30, 2016.
↵‡ Nov. 1, 2016, to Apr. 30, 2017.
- Table 2:
Morphine equivalents prescribed per hour worked before and after implementation of a guideline for the prescribing of restricted medications in the emergency department
Drug Before guideline implementation, MME After guideline implementation, MME Average reduction (95% CI) Average Median Average Median Hydromorphone IR 12.44 10.91 8.56 6.59 −3.88 (−5.70 to −2.05) Hydromorphone ER 1.66 0.63 0.98 0.00 −0.68 (−1.45 to 0.09) Morphine IR 0.85 0.54 0.72 0.42 −0.13 (−0.43 to 0.19) Morphine SR 0.65 0.00 0.26 0.00 −0.39 (−1.17 to 0.38) Oxycodone + acetaminophen tablets 0.07 0.00 0.08 0.00 0.01 (−0.10 to 0.13) Acetaminophen + caffeine + codeine tablets 2.84 2.08 2.62 1.72 −0.22 (−0.95 to 0.52) Total 18.51 16.07 13.22 11.22 −5.29 (−7.60 to −2.97) Note: CI = confidence interval, ER = extended release, IR = immediate release, MME = morphine milligram equivalent, SR = sustained release.
- Table 3:
Morphine equivalents prescribed per patient seen before and after implementation of the guideline
Drug Before guideline implementation, MME After guideline implementation, MME Average reduction (95% CI) Average Median Average Median Hydromorphone IR 6.84 6.24 4.62 4.14 −2.22 (−3.27 to −1.17) Hydromorphone ER 1.00 0.32 0.53 0.00 −0.47 (−0.97 to 0.04) Morphine IR 0.46 0.28 0.40 0.24 −0.06 (−0.23 to 0.11) Morphine SR 0.36 0.00 0.16 0.00 −0.20 (−0.66 to 0.25) Oxycodone + acetaminophen tablets 0.06 0.00 0.04 0.00 −0.02 (−0.10 to 0.08) Acetaminophen + caffeine + codeine tablets 1.65 1.25 1.39 0.99 −0.26 (−0.66 to 0.14) Total 10.36 8.86 7.14 6.18 −3.22 (−4.81 to −1.63) Note: CI = confidence interval, ER = extended release, IR = immediate release, SR = sustained release.
- Table 4:
Naloxone dispensed in Saskatoon Health Region by emergency medical service and emergency department pharmacy
Variable Before guideline implementation After guideline implementation Prehospital naloxone given by EMS No. of patients treated 39 39 Total drug administered, mg 23.4 34.5 No. of naloxone vials* dispensed to emergency departments 164 174 Emergency department 1 10 1 Emergency department 2 111 134 Emergency department 3 43 39 Note: EMS = emergency medical service.
↵* 2 mg/2 mL.
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