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919: INCIDENCE OF PRESCRIBING OPIOIDS AT HOSPITAL DISCHARGE AFTER ADMISSION TO A MEDICAL ICU

Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives: An opioid epidemic has significantly affected the United States over the past several decades; both the rate of opioid dependence and the rate of deaths related to opioid overdose have been steadily rising. Concomitantly, the rate of opioid prescribing has been increasing. The primary objective of this project is to identify risk factors associated with the receipt of opioid prescriptions at hospital discharge after admission to a medical intensive care unit (MICU), specifically in patients who were not previously on opioid therapy. Our hypothesis is that patients who are given continuous infusions of opioids, especially for an extended length of time or at a high rate, have a higher risk of being discharged with a prescription for opioids than patients who did not receive the same magnitude of therapy. Furthermore, we believe that this risk may be higher in patients admitted after the publication of new guidelines by the Society of Critical Care Medicine in early 2013. Methods: This is a retrospective, case-control study in the MICU at the University of Vermont Medical Center, a rural, academic medical center in Burlington, Vermont. The MICU is a 21-bed closed unit. An electronic medical record was used to identify patients 18 years of age and older who were admitted to the MICU between January 1, 2010 and September 30, 2015. Patients were excluded if they had recent history of opioid use, required treatment in the operating room during or prior to the admission, were admitted for trauma, or were receiving comfort measures only. Results: A total of 3351 patient encounters were identified that met inclusion and exclusion criteria. Of these, 318 encounters resulted in at least one opioid prescription at hospital discharge. Baseline characteristics were similar between groups except more patients in the case group had mechanical ventilation (17.6% vs. 11.3%, p = 0.0007), chest tubes (2.4% vs. 0.4%, p = 0.0002), and PEG tubes (1.1% vs. 0.08%, p = 0.0021). Continuous infusions of opioids were given to 25 (6.8%) patients in the case group vs. 252 (7%) patients in the control group (p = 0.1). Conclusions: In this retrospective, case-control study, use of continuous infusions of opioids was not associated with the incidence of opioid prescribing at hospital discharge.