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/目的：本研究针对2018年发布的经黏膜即刻释放芬太尼（transmucosal immediate-release fentanyl, TIRF）超说明书使用警告，评估了2019年与2022年马德里某急诊室的TIRF处方适宜性。
方法：检索该急诊室的TIRF处方记录，共纳入2019年的993例患者与2022年的1499例患者，其中随机纳入本研究的共140例，2019年与2022年各70例。依据既定标准分析TIRF的给药剂量适宜性与适应证。
结果：尽管癌症诊断比例较高（77.9%，109/140），但仅32.9%（46/140）的患者在入院前符合适宜性标准。出院时这一比例提升至42.5%（51/120），但整体变化未达到统计学意义。不过在存活患者中，适宜性比例从30.83%（37/120）显著提升至42.50%（p=0.002）。该改善在2022年尤为显著（p=0.0269），但2019年无明显变化（p=0.0771）。值得注意的是，既往有TIRF处方史的患者，其适宜性比例从入院前的46.75%相对稳定地维持至出院时的48.78%。另有两项不符合处方指南的值得关注的现象：68.75%的癌症患者出院时接受了低剂量阿片类药物治疗（<60吗啡毫克当量，morphine milligram equivalents, MME），且36.8%的80岁以上患者联合开具了苯二氮䓬类药物（benzodiazepines）。
结论：本研究发现急诊环境下TIRF处方不当的情况较为普遍，其常见诱因是院前阿片类药物剂量过低。尽管住院治疗改善了存活患者的TIRF处方适宜性，尤其是在2022年，但仍存在诸多令人担忧的不规范处方操作。这凸显了需加强相关教育与干预措施，以确保TIRF的安全、有效使用。