Creating an Opioid Recommendation Card for Trainees: Methods, Use, and Impact

Abstract

Background In academic hospitals, surgical residents write most of the postoperative prescriptions; yet, few residents are trained on postoperative analgesia. This leads to wide variability in practices and often excess opioid prescribing. We sought to create an opioid guideline pocket card for surgical residents to access when prescribing opioids postoperatively and to evaluate the impact of this initiative. Methods A comprehensive literature review was conducted to generate evidence-based procedure-specific opioid recommendations; additional recommendations were formulated via consensus opinion from surgical divisions at an academic institution. A pocket-sized guideline card was developed to include these procedure-specific recommendations as well as opioid guidelines for discharges after inpatient stays, non-opioid analgesic recommendations, access to opioid safety and disposal instructions for patients discharge, an equianalgesic dosing chart, and instructions for naloxone use. The card was distributed to all General Surgery house staff at a university-affiliated hospital in the spring of 2018. Following the distribution, trainees were surveyed on their use of the card. Descriptive statistics were used to analyze the survey. Results Of 85 trainees, 62 (72.9%) responded to the survey in full; 58% use the card regularly. Of the 27 junior resident respondents, 70.4% use the card at least monthly including 48.1% who use the card daily-to-weekly. Overall, 81.6% of residents changed their opioid-prescribing practices because of this initiative and 89.8% believe the card should continue to be distributed and used. Discussion An evidence-based guideline card for postoperative analgesia is highly valued and utilized by surgical trainees, especially those most junior in their training.

Variability in Opioid Prescribing Among Plastic Surgery Residents After Bilateral Breast Reduction

“…These findings are aligned with the premise that more junior residents have not yet developed habitual prescribing patterns and may be under more pressure to avoid reprimand for insufficient prescriptions, making them more responsive to evidence-based guidelines or protocols. 51 There are some important limitations to this study. First, as a retrospective chart review, the findings assume accurate and complete documentation.…”

“…There is already evidence within the plastic surgery literature that opioid restrictive protocols are effective at reducing opioid prescriptions 50 . A study by Freedman-Weiss and colleagues 51 found that a simple evidence-based guideline card for postoperative analgesia was effective in changing opioid prescribing practices among general surgery residents and was highly used among the most junior residents. These findings are aligned with the premise that more junior residents have not yet developed habitual prescribing patterns and may be under more pressure to avoid reprimand for insufficient prescriptions, making them more responsive to evidence-based guidelines or protocols 51 …”

Speaking Up – Evaluierung von Pocket Cards zur Förderung von Speaking Up in pädiatrischen Simulationen

“…Allerdings gibt es im Alltagviele Aspekte, die medizinisches Personal daran hindern ihre Bedenken zu äußern.Um diese Barrieren zu überwinden wurden nach einer ausführlichenLiteraturrecherche Pocket Cards entwickelt, die sowohl die Wichtigkeit verdeutlichenals auch bei der Durchführung helfen. Zur strukturierten Durchführung des SpeakingUp wurde das ISBAR-Schema angewendet 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 .…”

Guidelines Could Reduce Opioid Prescribing for Uncomplicated Distal Radius Fractures

“…Freedman-Weis and colleagues created opioid recommendation cards for postoperative pain management, which resulted in a notable decrease in the number of opioids prescribed by resident physicians and an increase in nonopioid pain management. 5 To complement these cards, there should be an increase in educational programs that focus on how to safely prescribe opioids for pain management.…”

“…Although general guidelines already exist for pain management after trauma, more practical, comprehensive, and specific opioid dosing recommendation cards for orthopedic injuries among adult and pediatric patients would be beneficial. Freedman-Weis and colleagues created opioid recommendation cards for postoperative pain management, which resulted in a notable decrease in the number of opioids prescribed by resident physicians and an increase in nonopioid pain management 5 . To complement these cards, there should be an increase in educational programs that focus on how to safely prescribe opioids for pain management.…”