This Consensus Statement provides recommendations on the prescription of pain medication at discharge from hospital for opioid-naïve adult patients who undergo elective surgery. It encourages health care providers (surgeons, anesthesiologists, nurses/nurse practitioners, pain teams, pharmacists, allied health professionals, and trainees) to (1) use nonopioid therapies and reduce the prescription of opioids so that fewer opioid pills are available for diversion and (2) educate patients and their families/caregivers about pain management options after surgery to optimize quality of care for postoperative pain. These recommendations apply to opioid-naïve adult patients who undergo elective surgery. This consensus statement is intended for use by health care providers involved in the management and care of surgical patients. A modified Delphi process was used to reach consensus on the recommendations. First, the authors conducted a scoping review of the literature to determine current best practices and existing guidelines. From the available literature and expertise of the authors, a draft list of recommendations was created. Second, the authors asked key stakeholders to review and provide feedback on several drafts of the document and attend an in-person consensus meeting. The modified Delphi stakeholder group included surgeons, anesthesiologists, residents, fellows, nurses, pharmacists, and patients. After multiple iterations, the document was deemed complete. The recommendations are not graded because they are mostly based on consensus rather than evidence. RÉSUMÉ Cette déclaration de consensus fait des recommandations pour la prescription d'analgésiques à la sortie de l'hôpital pour les patients adultes n'ayant jamais pris d'opiacés et qui subissent une intervention chirurgicale non urgente. Elle encourage les prestataires de soins de santé (chirurgiens, anesthésiologistes, infirmières et infirmiers, infirmières et infirmiers praticiens, équipes antidouleur, pharmaciens, professionnels de la santé et stagiaires) à (1) utiliser des traitements non opiacés et à réduire la prescription d'opiacés afin de réduire le nombre de pilules opiacées pouvant être détournées; et (2) à éduquer les patients, ainsi que leurs familles et soignants, sur les options de prise en charge de la douleur après l'opération afin d'optimiser la qualité des soins pour la douleur postopératoire. Ces recommandations s'appliquent aux patients adultes n'ayant jamais pris d'opioïdes et qui subissent une intervention chirurgicale non urgente. Cette déclaration de consensus est destinée à être utilisée par les prestataires de soins de santé impliqués dans la prise en charge des patients opérés et les soins qui leur sont apportés. Un processus Delphi modifié a été utilisé pour parvenir à un consensus sur les recommandations. Tout d'abord, les auteurs ont procédé à une de la portée de la littérature afin de déterminer les pratiques exemplaires actuelles et les lignes directrices existantes. À partir de la littérature disponible et de l'expertise des ...

Background: There has been an increase in opioid usage and opioid-related deaths. Opioids prescribed to surgical patients have similarly increased. The aim of this study was to assess opioid consumption in patients undergoing laparoscopic appendectomy (LA) and laparoscopic cholecystectomy (LC) and to determine whether a standardized prescription could affect opioid consumption without affecting patient satisfaction. Methods: Patients undergoing LA or LC were recruited prospectively during 2 time periods (April to June 2017 and November 2017 to January 2018). In the first phase, surgeons continued their usual postoperative analgesia prescribing patterns. In the second phase, a standardized prescription was implemented. Patients were contacted by telephone and a questionnaire was completed for both phases of the study. The primary outcome was the quantity of opioids prescribed and consumed. Results: In the first phase, 166 patients who underwent LC or LA were recruited. The median number of prescribed opioid tablets was 20 and the median number consumed was 2. Ninety-five percent of patients reported satisfaction with their analgesia. Based on these results, a standardized prescription for multimodal analgesia was implemented for the second phase, consisting of 10 opioid tablets. In the second phase, 129 patients who underwent LA or LC were recruited. There was a significant decrease in the median number of opioid pills filled (10) and consumed (0), with no difference in reported satisfaction with analgesia. Conclusion: Patients are prescribed an excess of opioids after LA or LC. Implementation of a standardized prescription based on a quality improvement intervention was effective at decreasing the number of opioids prescribed and consumed.

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With the current push towards using fewer antipsychotics and more non-pharmacological interventions in long-term care, it has become increasingly important for knowledge and best-practice sharing across the province. The “Good Ideas” project began in 2001 in the context of my work as a Royal Ottawa geriatric psychiatry behavioural support outreach nurse to long-term-care facilities in Ottawa. A toolkit was begun as various ideas and tools were found to be useful in the management of behavioural challenges in the care of long term care residents. These non-pharmacological tools can have a significant impact on the management of behavioural challenges. Some were discovered via “out-of-the-box” thinking, some as a result of exploring possibilities on the Web, others were shared with me by colleagues in various roles and settings. I have worked in geriatric psychiatry in various capacities as a nurse at The Royal Ottawa Health Care Group since 1986, and have had the opportunity to accumulate several “good ideas” over time. I found myself carrying various articles, pamphlets, booklets, photos in my workbag and noticed I was being contacted more frequently over time on how to obtain certain items. When these non-pharmacological approaches were implemented, and successful, a common response would be: “what a good idea!” Thus, the name given to the project came to be. Good Ideas has grown over the years as the information has been shared with outreach team members and utilized in their own practice. All contacts are encouraged to share any new “good ideas” they encounter so those too can be added. Originally a hardcopy handout with a list and the resources to outsource items was created and distributed. This evolved into a PowerPoint presentation explaining the usefulness of each tool in specific target behaviours and how to obtain the tool, as well as photos. Later a poster was made and a second version was produced more recently. Currently the project is in the process of being translated to French for our bilingual Ottawa area. The project has circulated among my teammates to be used in education sessions in their long-term-care facilities or as an adjunct to larger full day education sessions on the topic of dementia care. A large colorful hatbox also contains some sample items to add to the hard copies. Good Ideas has been presented at the Regional Geriatric Program Annual Meeting poster presentation Oct 12, 2013, with very positive feedback from participants. Good Ideas is a project in perpetuity, with no stop date planned. It is my hope it will continue to grow long after my retirement date. It promotes the concept of creative thinking about behavioural challenges in dementia care, while supporting that pharmacological intervention should most often be as a last resort.