Opioid information pamphlet increases postoperative opioid disposal rates: a before versus after quality improvement study
Opioid information pamphlet increases postoperative opioid disposal rates: a before versus after quality improvement study
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DOI：
10.1007/s12630-015-0502-0
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发表时间：
2016-01-01
影响因子：
4.2
通讯作者：
Tang, Raymond
中科院分区：
文献类型：
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作者：
Rose, Peter;Sakai, Jenni;Tang, Raymond
一半的术后患者被开了阿片类药物，但大多数人没有正确储存或处理它们，因此有转移的风险。我们研究了阿片类药物教育小册子解决阿片类药物断奶，储存和处置的有效性。我们假设，小册子将增加适当的阿片类药物的处置率，存储，和weaning.This前瞻性研究之前和之后在UBC医院进行的初次全髋关节或膝关节置换术患者。美国麻醉医师协会身体等级I-III的成年人，没有成瘾史，每天消耗千分之一的吗啡当量30 mg。两组均接受类似的标准管理，但干预组在此基础上额外接受阿片类药物教育手册。术后4周联系患者完成调查。主要终点是评价适当的阿片类药物处置率。次要终点是评估阿片类药物储存和脱机率，226例患者入组，172例（76%）完成调查。在停用阿片类药物的患者中，接受小册子的患者中，适当处置率从2/42（5%）增加到12/45（27%）（比例差异为22%; 95%置信区间（CI）为5至38; P = 0.005）。在接受阿片类药物小册子的患者中，安全的阿片类药物储存没有改善[之前，18/86（21%）vs之后，20/86（23%）;比例差异为3%; 95% CI，-11至15; P = 0.713]。停用阿片类药物的患者比例在小册子前没有变化[之前，42/86（49%）vs之后，45/86（52%; P = 0.735]。
Half of postoperative patients are prescribed an opioid, but a majority do not store or dispose of them properly thus risking diversion. We examined the efficacy of an opioid educational pamphlet addressing opioid weaning, storage, and disposal. We hypothesized that the pamphlet would increase the rate of proper opioid disposal, storage, and weaning.This prospective before and after study was conducted at UBC Hospital in primary total hip or knee arthroplasty patients. Adults with American Society of Anesthesiologists physical class I-III, with no addiction history and consuming a parts per thousand currency sign 30 mg of morphine equivalents daily were enrolled in the study. Two groups received similar standard management, except the intervention group additionally received the opioid education pamphlet. Patients were contacted four weeks postoperatively to complete a survey. The primary endpoint was to evaluate proper opioid disposal rates. Secondary endpoints were to evaluate opioid storage and weaning rates.Two hundred twenty-six patients were enrolled and 172 (76%) completed the survey. Among patients who had discontinued opioids, rates of proper disposal increased from 2/42 (5%) to 12/45 (27%) in those receiving the pamphlet (difference in proportions, 22%; 95% confidence interval (CI), 5 to 38; P = 0.005). Secure opioid storage did not improve in those receiving the opioid pamphlet [before, 18/86 (21%) vs after, 20/86 (23%); difference in proportions, 3%; 95% CI, -11 to 15; P = 0.713]. The proportion of patients weaned from opioids was unchanged by the pamphlet [before, 42/86 (49%) vs after, 45/86 (52%); P = 0.735].The introduction of an education pamphlet significantly improved self-reported proper opioid disposal rates in postoperative patients.