Dataset: Appropriateness of TIRF Prescribing in the Emergency Room, During Hospitalization, and at Discharge: A Retrospective Study

Abstract:. Background/Objectives: This study evaluated the appropriateness of transmucosal im-mediate-release fentanyl (TIRF) prescriptions in a Madrid emergency room during 2019 and 2022, following a 2018 warning about off-label use; Methods: TIRF prescription in the emergency room search yielded 993 patients in 2019 and 1499 in 2022, of which 140 were randomized for the study, 70 in 2019, and 70 in 2022. Dose appropriateness and indication for TIRF were analyzed according to established criteria; Results: Despite a high prevalence of cancer diagnoses (77.9%, 109/140), only 32.9% (46/140) of patients met the appropriateness criteria pre-hospitalization. This improved to 42.5% (51/120) at discharge, but the change was not statistically significant overall. However, among surviving patients, appropriateness significantly improved from 30.83% (37/120) to 42.50% (p=0.002). However, focusing on surviving patients reveals a significant improvement in appropri-ateness, increasing from 30.83% (37/120) to 42.50% (p=0.002). This improvement was particularly pronounced in 2022 (p=0.0269), but not in 2019 (p=0.0771). Interestingly, appropriateness in patients with prior TIRF prescriptions remained relatively stable from pre-hospitalization (46.75%) to dis-charge (48.78%). A concerningly high proportion of patients with cancer diagnoses (68.75%) re-ceived low-dose opioid therapy (<60 MME) at discharge, and 36.8% of patients over 80 years old were co-prescribed benzodiazepines, contradicting prescribing guidelines; Conclusions: This study found inappropriate TIRF prescriptions were common in an emergency room setting, often due to low pre-hospital opioid doses. While hospitalization improved TIRF appropriateness in survivors, especially in 2022, concerning prescribing practices persisted. This emphasizes the need for better education and interventions to ensure safe and effective TIRF use.

摘要：
背景与研究目的：本研究针对2018年发布的超说明书用药警示，评估了2019年与2022年马德里某急诊室的经黏膜即刻释放芬太尼（transmucosal immediate-release fentanyl, TIRF）处方适宜性。
方法：检索该急诊室的TIRF处方，2019年共纳入993例患者，2022年共纳入1499例患者，其中随机选取140例纳入本研究，2019年、2022年各70例。依据既定标准分析TIRF的剂量适宜性与用药指征。
结果：尽管癌症诊断患者占比极高（77.9%，109/140），但仅32.9%（46/140）的患者在入院前符合用药适宜性标准。出院时该比例升至42.5%（51/120），但整体变化未达到统计学显著性。不过在存活患者中，用药适宜性占比从30.83%（37/120）显著提升至42.50%（p=0.002）。进一步细分可见，这一改善在2022年尤为显著（p=0.0269），但2019年未出现统计学意义上的提升（p=0.0771）。值得注意的是，既往有TIRF处方史的患者，其适宜性占比从入院前的46.75%小幅升至出院时的48.78%，整体保持相对稳定。另有两项值得关注的现象：68.75%的癌症诊断患者在出院时接受了低于60毫克吗啡当量（<60 MME）的低剂量阿片类药物治疗，且36.8%的80岁以上患者联合开具了苯二氮䓬类药物，这与处方指南相悖。
结论：本研究发现，急诊场景下TIRF处方不当的情况较为普遍，常见诱因是入院前阿片类药物剂量偏低。尽管住院治疗可提升存活患者的TIRF用药适宜性，尤其是在2022年，但仍存在诸多令人担忧的处方不规范行为。这凸显了开展针对性教育与干预措施的必要性，以确保TIRF的安全、有效使用。