A Goal-directed Quality Improvement Initiative to Reduce Opioid Prescriptions After Orthopaedic Procedures
A Goal-directed Quality Improvement Initiative to Reduce Opioid Prescriptions After Orthopaedic Procedures
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DOI：
10.5435/jaaosglobal-d-19-00109
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发表时间：
2019-09-01
影响因子：
1.5
通讯作者：
Hansen, Erik N.
中科院分区：
文献类型：
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作者：
Choo, Kevin J.;Grace, Trevor R.;Hansen, Erik N.
简介：整形外科医生越来越意识到阿片类药物流行的有害影响以及过度处方与转向非医疗阿片类药物使用或药物滥用之间的关联。出院时的阿片类药物处方已被确定为干预目标。本研究描述了旨在通过向提供者提供有关其处方模式的常规反馈来减少阿片类药物过度处方的目标导向干预的成功结果。方法：前瞻性收集向骨科手术后出院时未使用阿片类药物的成人患者提供的阿片类药物的数量，量化为口服吗啡当量（OME）。作为机构质量改进计划的一部分，医疗服务提供者每 2 个月收到一份报告，详细说明了规定的中位出院 OME 以及随时间变化的趋势。 6个月后，对干预前和干预患者队列进行回顾性比较。结果：干预前队列有401名患者，干预队列有429名患者。两组在年龄、性别、抑郁发生率、手术时间、住院时间、骨科亚专科以及出院前住院阿片类药物需求方面相似。干预队列中的患者服用的阿片类药物明显减少了 25%，相当于 20 片 5 mg 羟考酮速释片（450 与 600 OME，P < 0.001）。尽管有这些阿片类药物，出院后前 90 天的阿片类药物补充率在各组之间没有显着变化。讨论：明智地治疗术后疼痛，同时避免阿片类药物过量处方是至关重要的。这项研究证明了减少阿片类药物过度处方的目标导向举措的结果。该举措减少了出院阿片类药物处方，但并未增加术后需要补充处方的风险。这表明这种方法可以减少阿片类药物的使用，同时仍然为患者提供适当的护理和疼痛控制。
Introduction: Orthopaedic surgeons are increasingly aware of deleterious effects of the opioid epidemic and the association between overprescription and diversion toward nonmedical opioid use or substance abuse. Opiate prescriptions at the time of hospital discharge have been identified as target for intervention. This study describes the successful outcome of a goal-directed intervention aimed at decreasing opioid overprescription by providing routine feedback to providers regarding their prescribing patterns.Methods: The amount of opioid medications, quantified as oral morphine equivalents (OMEs), provided to opioid-naive adult patients on discharge after orthopaedic surgery was prospectively collected. As part of an institutional quality improvement initiative, medical providers received reports every 2 months detailing median discharge OMEs prescribed, trended over time. After 6 months, a retrospective comparison was done between preintervention and intervention patient cohorts.Results: There were 401 patients in the preintervention cohort and 429 patients in the intervention cohort. Both groups were similar in regard to age, sex, rates of depression, surgical time, length of stay, orthopaedic subspecialty, and inpatient opioid requirement before discharge. Patients in the intervention cohort were prescribed markedly fewer opioid medications by 25%, equivalent to 20 tablets of 5-mg oxycodone IR (450 versus 600 OMEs, P < 0.001). Despite these opioid medications, opioid refill rates during the first 90 days after discharge did not markedly change between groups.Discussion: It is critical to judiciously treat postoperative pain while avoiding opioid overprescription. This study demonstrated the outcome of a goal-directed initiative to decrease overprescription of opioid medications. The initiative reduced discharge opioid prescriptions yet did not increase the risk of requiring a prescription refill in the postoperative period. This indicates that such an approach can result in opioid reduction, while still providing appropriate care and pain control for patients.