Postoperative Opiate Use in Urological Patients: A Quality Improvement Study Aimed at Improving Opiate Disposal Practices
Postoperative Opiate Use in Urological Patients: A Quality Improvement Study Aimed at Improving Opiate Disposal Practices
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DOI：
10.1016/j.juro.2018.09.052
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发表时间：
2019-02-01
影响因子：
6.6
通讯作者：
Scarpato, Kristen R.
中科院分区：
文献类型：
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作者：
Cabo, Jackson;Hsi, Ryan S.;Scarpato, Kristen R.
目的：通过介绍一份教育讲义，确定泌尿外科患者术后阿片类药物管理的趋势，找出与阿片类药物保存的关系，并促进术后适当的阿片类药物处理。材料和方法：我们回顾分析了68例泌尿外科手术患者的阿片类药物使用情况。在59名患者的单独连续队列中，我们分发了一份讲义，详细说明了FDA(食品和药物管理局)批准的处置方法。通过使用田纳西州受控物质监测数据库(CSMD)核实的处方配药数据，通过电话采访评估患者阿片类药物的获得、使用和处置。阿片类药物保留定义为术后3周或术后处方持续时间的4倍以上，以时间较长者为准。结果：在我们最初的队列中，有41例患者(72%)观察到阿片类药物保留。在这些患者中，68%的人把药物放在家里没有固定。处理阿片类药物的主要障碍包括44%的患者担心疾病特异性疼痛的复发，29%的患者担心无关的疼痛。根据一项简短的测试评估，与非持有鸦片的人相比，持有鸦片类药物的人对安全处置实践的了解较少(72%对85%，p=0.005)。在阿片类药物保管者中，干预后知识得分有改善(66%至77%，p=0.03)。教育前和教育后相比，阿片类药物的持有率(72%比68%，p=0.66)和正确处理的比例(9%比8%，p=1.0)没有明显的改善。结论：阿片类药物的保存在泌尿外科手术后很常见，处理的一个主要障碍是担心疾病特异性疼痛的复发。未来旨在限制阿片类药物保留的干预措施应该结合循证处方做法和有针对性的患者教育。
Purpose: We aimed to determine trends in postoperative opiate management among urological patients, identify associations with opiate keeping and foster appropriate opiate disposal after surgery via introduction of an educational handout.Materials and Methods: We retrospectively analyzed opiate practices in 68 patients who had undergone urological surgery. In a separate consecutive cohort of 59 patients we distributed a handout detailing FDA (Food and Drug Administration) approved disposal methods. Patient opiate obtainment, use and disposal were assessed via telephone interviews with prescription filling data verified using the Tennessee CSMD (Controlled Substances Monitoring Database). Opiate keeping was defined as possessing any opiates more than 3 weeks after surgery or more than 4 times the duration of the postoperative prescription, whichever was longer.Results: Opiate keeping was observed in 41 patients (72%) in our initial cohort. Of these patients 68% left the medication unsecured at home. Major barriers to opiate disposal included concern for return of disease specific pain in 44% of patients and unrelated pain in 29%. As assessed on a short test, opiate keepers were less knowledgeable about safe disposal practices compared to nonkeepers (72% vs 85%, p = 0.005). Among opiate keepers there was an improvement in knowledge scores after the intervention (66% to 77%, p = 0.03). When comparing pre-education to post-education, there was no detectable improvement in the rate of opiate keeping (72% vs 68%, p = 0.66) or proper disposal (9% vs 8%, p = 1.0).Conclusions: Opiate keeping is common following urological surgery and a major barrier to disposal is concern for the return of disease specific pain. Future interventions aimed at limiting opiate keeping should combine evidence-based prescription practices and targeted patient education.