Nafisseh S Warner1, Dawn Finnie2, David O Warner3, W Michael Hooten3, Karen F Mauck4, Julie L Cunningham5, Halena Gazelka3, Mohamad Bydon6, Paul M Huddleston7, Elizabeth B Habermann2. 1. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN. Electronic address: warner.nafisseh@mayo.edu. 2. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN. 3. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN. 4. Department of General Internal Medicine, Mayo Clinic, Rochester, MN. 5. Department of Pharmacy, Mayo Clinic, Rochester, MN. 6. Department of Neurological Surgery, Mayo Clinic, Rochester, MN. 7. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
Abstract
OBJECTIVE: To elucidate factors that influence opioid prescribing behaviors of key stakeholders after major spine surgery, with a focus on barriers to optimized prescribing. METHODS: In-person semi-structured interviews were performed with 20 surgical and medical professionals (January 23, 2019 to June 11, 2019) at a large academic medical center, including resident physicians, midlevel providers, attending physicians, and clinical pharmacists. Interviews centered on perceptions of postoperative prescribing practices were coded and analyzed using a qualitative inductive approach. RESULTS: Several unique themes emerged. First, wide interprovider variation exists in the perceived role of opioid prescribing guidelines. Second, there are important relationships between clinical experience, time constraints, and postoperative opioid prescribing. Third, opioid tapering is a major area of inconsistency. Fourth, there are serious challenges in managing analgesic expectations, particularly in those with chronic pain. Finally, there is currently no process to facilitate the hand-off or transition of opioid prescribing responsibility between surgical and primary care teams, which represents a major area for practice optimization efforts. CONCLUSION: Despite increased focus on postoperative opioid prescribing, there remain numerous areas for improvement. The development of tools and processes to address critical gaps in postoperative prescribing will be essential for our efforts to reduce long-term opioid use after major spine surgery and improve patient care.
OBJECTIVE: To elucidate factors that influence opioid prescribing behaviors of key stakeholders after major spine surgery, with a focus on barriers to optimized prescribing. METHODS: In-person semi-structured interviews were performed with 20 surgical and medical professionals (January 23, 2019 to June 11, 2019) at a large academic medical center, including resident physicians, midlevel providers, attending physicians, and clinical pharmacists. Interviews centered on perceptions of postoperative prescribing practices were coded and analyzed using a qualitative inductive approach. RESULTS: Several unique themes emerged. First, wide interprovider variation exists in the perceived role of opioid prescribing guidelines. Second, there are important relationships between clinical experience, time constraints, and postoperative opioid prescribing. Third, opioid tapering is a major area of inconsistency. Fourth, there are serious challenges in managing analgesic expectations, particularly in those with chronic pain. Finally, there is currently no process to facilitate the hand-off or transition of opioid prescribing responsibility between surgical and primary care teams, which represents a major area for practice optimization efforts. CONCLUSION: Despite increased focus on postoperative opioid prescribing, there remain numerous areas for improvement. The development of tools and processes to address critical gaps in postoperative prescribing will be essential for our efforts to reduce long-term opioid use after major spine surgery and improve patient care.
Authors: Kevin Berardino; Austin H Carroll; Alicia Kaneb; Matthew D Civilette; William F Sherman; Alan D Kaye Journal: Orthop Rev (Pavia) Date: 2021-06-22
Authors: Sabina Schaffer; Dunya Bayat; Walter L Biffl; Jeffrey Smith; Kathryn B Schaffer; Tala H Dandan; Jiayan Wang; Deb Snyder; Chris Nalick; Imad S Dandan; Gail T Tominaga; Matthew R Castelo Journal: Trauma Surg Acute Care Open Date: 2022-03-24