Alexander S Chiu1, Mollie R Freedman-Weiss1, Raymond A Jean1, Elizabeth Cohen2, Peter S Yoo3. 1. Department of Surgery, Yale School of Medicine, New Haven, CT. 2. Department of Pharmacy, Yale School of Medicine, New Haven, CT. 3. Department of Surgery, Yale School of Medicine, New Haven, CT. Electronic address: Peter.Yoo@Yale.edu.
Abstract
BACKGROUND: Surgeons have the opportunity to help offset the opioid epidemic by leading with practice changes. We sought to decrease the amount of opioid prescribed postoperatively through a multifaceted program. METHODS: A multipronged program was introduced in our hospital system, which included resident education on prescribing for postoperative analgesia, a change in the default number of opioid pills in an electronic medication order entry system, and the distribution of a guideline card of recommended postoperative opioid prescription amounts. The amount of opioid prescribed postoperatively between January 2016 and August 2018 was collected for the 10 most common short-stay (<48 hours) general surgery procedures. The 6 months prior to any intervention (pre-intervention) was compared to the last 6 months of data collection (post-intervention). RESULTS: In the study, 14,007 operations were captured, including 2,530 pre-intervention and 2,715 post-intervention. The average amount of postoperative opioid prescribed in the pre-intervention period was 207.1 morphine milligram equivalents; post-interventions, the average amount declined to 104.6 morphine milligram equivalents (P < .01). The opioid refill rate remained the same (3.3% pre-intervention vs 3.1% post-intervention, P = .76). CONCLUSION: A comprehensive program to eliminate the over-prescription of opioids decreased the amount of opioid prescribed by half, without a concurrent increase in opioid refills, demonstrating that simple measures can be used to deliver sustained and reproducible improvements in offering source control in the opioid epidemic.
BACKGROUND: Surgeons have the opportunity to help offset the opioid epidemic by leading with practice changes. We sought to decrease the amount of opioid prescribed postoperatively through a multifaceted program. METHODS: A multipronged program was introduced in our hospital system, which included resident education on prescribing for postoperative analgesia, a change in the default number of opioid pills in an electronic medication order entry system, and the distribution of a guideline card of recommended postoperative opioid prescription amounts. The amount of opioid prescribed postoperatively between January 2016 and August 2018 was collected for the 10 most common short-stay (<48 hours) general surgery procedures. The 6 months prior to any intervention (pre-intervention) was compared to the last 6 months of data collection (post-intervention). RESULTS: In the study, 14,007 operations were captured, including 2,530 pre-intervention and 2,715 post-intervention. The average amount of postoperative opioid prescribed in the pre-intervention period was 207.1 morphine milligram equivalents; post-interventions, the average amount declined to 104.6 morphine milligram equivalents (P < .01). The opioid refill rate remained the same (3.3% pre-intervention vs 3.1% post-intervention, P = .76). CONCLUSION: A comprehensive program to eliminate the over-prescription of opioids decreased the amount of opioid prescribed by half, without a concurrent increase in opioid refills, demonstrating that simple measures can be used to deliver sustained and reproducible improvements in offering source control in the opioid epidemic.
Authors: Katherine B Santosa; Christine S Wang; Hsou-Mei Hu; Chad M Brummett; Michael J Englesbe; Jennifer F Waljee Journal: Am J Surg Date: 2020-06-19 Impact factor: 2.565