Educating surgical oncology providers on perioperative opioid use: A departmental survey 1 year after the intervention

Abstract

Background and Objectives A department‐wide opioid reduction education program resulted in a 1‐month change in perceptions of opioid needs and prescribing recommendations for surgical oncology patients. This study's aim was to re‐evaluate if early trends were retained 1 year later. Methods Surgical Oncology attendings, fellows, and advanced practice providers at a Comprehensive Cancer Center were surveyed 1‐year after an August 2018 opioid reduction education program, to compare departmental and individual opioid prescribing habits. Results The September 2019 response rate was 54/93 (58%), with 41 completing both the post‐education and 1‐year follow‐up surveys. The departmental and matched cohort continued to recommend a lower quantity of discharge opioids for all five index operations (by >50%) and expected less postoperative days to zero opioid needs, when compared to pre‐education perceptions. Providers continued to agree that discharge opioid prescriptions should be based on a patient's last 24 hours of inpatient opioid use. There was universal agreement that each respondent's opioid administration had decreased in the past year. Conclusions The initial 1‐month improvements in perioperative opioid prescribing perceptions were retained 1 year later by Surgical Oncology providers who recommended fewer discharge opioids, faster weaning to zero opioids, and standardized patient‐specific discharge opioid volume calculations.

Sustained reduction in discharge opioid volumes through provider education: Results of 1168 cancer surgery patients over 2 years

“…The education sessions that followed had dramatically corrected perceptions of opioid prescribing needs and reduced knowledge deficits when we resurveyed our providers 1 month after the sessions. These changes in perception and knowledge were retained 1 year later in a recent follow‐up survey 18,19 . The current study subsequently quantified the practice changes suggested by those surveys into actual amounts of opioids prescribed.…”

“…Subsequently, education sessions were conducted over the course of 1 week in several different forums, as described below. The same survey measurements were taken 1 month later, in September 2018, 18 and 1 year later, in September 2019, 19 and demonstrated dramatic improvement in perceptions of opioid needs of patients and self‐reported reductions in opioid prescriptions by providers of all levels, which were retained at the 1‐year assessment. The current study, therefore, served to quantify actual prescription volumes these survey results suggested.…”

“…Through our department's learning healthcare system model, a structure for the opioid reduction was developed on a gradual foundation of patient and provider buy‐in with four strategic pillars, which again are: (1) opioid education for providers and patients, (2) limiting peak and total inpatient opioid exposure, (3) aggressive inpatient opioid weaning, and (4) standardization of discharge opioid prescriptions 19 . This four‐pillar strategy can be incorporated into an opioid‐reduction continuum throughout the patient's perioperative course to reduce the area under the curve (total opioid exposure) and to reduce or eliminate the final tail (discharge prescription volume, Figure 4).…”

“…This emphasis on standardizing and reducing the discharge opioid volume was based on a Centers for Disease Control and Prevention publication in 2017, showing inflection points in persistent opioid use (1 and 3 years after discharge) in patients who received initial opioid prescriptions greater than 5 days’ supply 21,22 . The survey responses, which have been published, indicated that the vast majority of all staff members participated in the educational sessions 18,19 …”

“…In the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center, a perioperative opioid reduction education initiative was implemented to reduce inpatient opioid use, accelerate opioid weaning, and reduce discharge opioid dissemination in surgical oncology patients. This prospective quality improvement project was structured around our “four pillars” of opioid reduction and supplemented with patient‐centered recommendations for discharge prescriptions 17–19 . The objective of this study was to measure the effectiveness and sustainability of this department‐wide training in terms of the volume of discharge opioids prescribed after inpatient cancer surgery over the course of the year beyond the intervention.…”