Characterization of inpatient care for patients admitted to a psychiatric hospital with a home opioid prescription

Abstract

Introduction: Patients with mental illness are particularly at risk for OUD, and due to this higher risk, providers may be more inclined to withhold their home opioids when they are admitted to a psychiatric hospital. Patients whose home opioids are continued or withheld during admission may be treated differently with respect to pain control, orders for nonopioid adjunctive pain agents, orders for intramuscular as-needed medications, orders for seclusion and/or restraints, and outpatient referrals for OUD treatment. The objective of this retrospective pilot study was to characterize inpatient care for these 2 patient populations. Methods: Thirty-one inpatient encounters were reviewed for patients who had opioid prescriptions before admission and were discharged from the medical center’s psychiatric service from June 1 through August 31, 2019. Results: Orders for nonopioid adjunctive pain agents and intramuscular as-needed medications trended higher for the opioid-withheld group, suggesting greater polypharmacy and patient dissatisfaction compared with the opioid-continued group. Additionally, what became evident was the lack of consistent and clear documentation regarding the discharge plans for the patients’ home opioid and OUD treatment. Discussion: These findings may prompt inpatient interdisciplinary teams to develop a better process of documentation to facilitate continuity of care.