Standardizing Opioid Prescriptions to Patients After Ambulatory Oncologic Surgery Reduces Overprescription.
Standardizing Opioid Prescriptions to Patients After Ambulatory Oncologic Surgery Reduces Overprescription.
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DOI：
10.1016/j.jcjq.2020.04.004
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发表时间：
2020-07
影响因子：
2.3
通讯作者：
Laudone VP
中科院分区：
文献类型：
--
作者：
Fearon NJ;Benfante N;Assel M;Chesnut GT;Vickers A;Levine M;Broach V;Simon BA;Twersky R;Laudone VP
手术后过量服用阿片类药物会导致长期滥用。评估阿片类药物处方模式和患者报告的阿片类药物使用情况提供了一种基于证据的方法来识别潜在的过度处方。这项质量改进计划旨在减少门诊肿瘤手术中心出院后的阿片类药物处方并使其标准化，并评估这一变化对患者随后的阿片类药物使用和报告的疼痛的影响。 2018年3月至2019年1月期间，对年龄≥18岁的连续使用过阿片类药物的患者进行了机器人或腹腔镜子宫切除术、根治性前列腺切除术或部分肾切除术或全乳房切除术（伴或不伴立即重建）术后7-10天的调查。在标准化前 (n = 551) 和标准化后 (n = 480) 队列中收集的数据包括对疼痛缓解的感知、处方阿片类药物（通过电子病历审查验证）和消耗以及收到的补充。标准化前，出院时阿片类药物处方中位数为 20 粒药片（四分位数范围 [IQR] 20-28）或 140 口服吗啡毫克当量 (MME)（IQR 100-150）。所有服务中阿片类药物消耗量的中位数为 2 粒药片 (IQR 0–7) 或 10 MME (IQR 0–40)。后来，妇科、泌尿科和乳腺科的阿片类药物处方分别标准化为 7、8 和 10 片（35、40 和 75 MME）。这一变化与报告的疼痛增加无关。所有手术后的补充请求从 4.4% 增加到 7.7%，其中接受乳房手术的患者增幅最大。可以安全地减少接受门诊或短期癌症手术的患者出院时服用的阿片类药物的数量。
Overprescribing of opioids after surgery contributes to long-term abuse. Evaluating opioid prescription patterns and patient-reported opioid use offers an evidence-based method to identify potential overprescription. This quality improvement initiative aimed to reduce and standardize opioid prescriptions upon discharge from an ambulatory oncologic surgery center and evaluate the effect of this change on patients’ subsequent opioid use and reported pain. Between March 2018 and January 2019, consecutive opioid-naïve patients aged ≥ 18 years who underwent robotic or laparoscopic hysterectomy, radical prostatectomy, or partial nephrectomy, or total mastectomy with or without immediate reconstruction were surveyed 7–10 days postoperatively. Data collected in the pre- (n = 551) and post-standardization (n = 480) cohorts included perception of pain relief, opioids prescribed (verified by electronic medical record review) and consumed, and refills received. Pre-standardization, the median opioid prescription at discharge was 20 pills (interquartile range [IQR] 20–28) or 140 oral morphine milligram equivalents (MME) (IQR 100–150). Median opioid consumption was 2 pills (IQR 0–7) or 10 MME (IQR 0–40) among all services. Opioid prescriptions were later standardized to 7, 8, and 10 pills (35, 40, and 75 MME), in the gynecology, urology, and breast services, respectively. The change was not associated with an increase in reported pain. Refill requests increased postintervention across all surgeries from 4.4% to 7.7%, with the largest increase among patients who underwent breast surgery. The number of opioid pills given at discharge to patients undergoing ambulatory or short-stay cancer surgery can safely be reduced.
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DOI：
10.1136/bmj.g1251
发表时间：
2014-02-11
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Clarke H;Soneji N;Ko DT;Yun L;Wijeysundera DN
通讯作者：
Wijeysundera DN
影响因子：
9
作者：
Hill, Maureen V.;McMahon, Michelle L.;Barth, Richard J. Jr
通讯作者：
Barth, Richard J. Jr
影响因子：
9
作者：
Hill, Maureen V.;Stucke, Ryland S.;Barth, Richard J., Jr.
通讯作者：
Barth, Richard J., Jr.
影响因子：
2.5
作者：
Murphy, Brittany L.;Thiels, Cornelius A.;Habermann, Elizabeth B.
通讯作者：
Habermann, Elizabeth B.
影响因子：
3.7
作者：
Bartels, Karsten;Mayes, Lena M.;Binswanger, Ingrid A.
通讯作者：
Binswanger, Ingrid A.