Discharging Inpatients on Opioid Medications

When discharging a patient following hospitalization on new pain medication:
  • Consider how much pain medication patient will need until follow-up with primary care doctor. Ideally, patient should have enough pain medication to last until his/her follow-up appointment (when taken correctly).
  • Give clear instructions on how to take medication safely, including discussing potential side effects and what to do if pain becomes uncontrolled (return to emergency room/call clinic).
  • If being discharged on pain medication different from medicine received while inpatient (e.g. patient received IV morphine while inpatient, but will be discharged on PO oxycodone), then convert patient’s total 24 hour inpatient pain medication regimen to near equivalent dosage of pain medication regimen patient will be able to take as outpatient (i.e. what is available at patient’s pharmacy or what insurance will cover).
  • Consider whether patient will have decreasing need for pain medications in days following discharge.
  • Inform the patient that the ultimate decision about further prescribing of pain medication will be based on their primary-care doctor’s assessment.  If there are concerns about the safety of prescribing pain medications to patient, discuss with primary care doctor to coordinate plans.
  • Ultimately, same rules apply to prescribing opioids at discharge from inpatient setting as they do in outpatient setting (i.e. if potential risks outweigh expected benefits from medication, then the opioid should not be prescribed).
  • If patient has existing opioid agreement with primary care doctor, the primary care office should be contacted to coordinate care, and last doses of narcotics should be documented if patient is expected to submit urine toxicology screen at primary care doctor or substance abuse program.
  • Include pertinent information on discharge summary (e.g. urine tox results, medications prescribed at discharge).
  • Discuss non-pharmacological ways to deal with pain (e.g. warm/cold compress, massage, acupuncture, physical therapy).