Impact of Standardized Prescribing Guidelines on Postoperative Opioid Prescriptions after Ophthalmic Surgery

Abstract

To determine the effect of implementing standardized opioid prescribing guidelines on prescription patterns for acute pain after ophthalmic surgery in opioid-naïve patients.Design: Quality improvement study.Participants: Ophthalmic surgeons in an academic department of ophthalmology. Methods: Postoperative opioid prescribing patterns were compared before and after the implementation of standardized opioid prescribing guidelines for ophthalmic surgery at an academic institution. Only prescriptions provided to opioid-naïve patients 18 years of age or older were included. Surgeons reached a consensus for standardized prescribing guidelines appropriate for the type of surgery within their subspecialty. Guidelines were disseminated in conjunction with postsurgical pain management education to all ophthalmologists in the department, including trainees. The frequency of opioid prescriptions, the quantity of opioid prescribed (converted to oral morphine equivalent [OME]), and opioid prescription refill rates were compared before and after intervention.Main Outcome Measures: Prescriptions with more than 80 OME, frequency of opioid prescriptions, mean OME, and refill rates.Results: Of 5349 ophthalmic surgeries performed during the 2 assessment periods, 196 (3.7%) were associated with opioid prescriptions for acute postoperative pain. The frequency of opioid prescriptions decreased to 3.0% (81/2736) after intervention compared with 4.4% (115/2613) before intervention (P ¼ 0.005). When opioids were prescribed, the mean OME decreased from 93 (range, 27e500) before intervention to 42 (range, 14e100) after intervention (P ¼ 0.003). The number of prescriptions for more than 80 OME decreased from 56 (2.1%) before intervention to 4 (0.1%) after intervention (P < 0.001). Based on the standardized guidelines, 103 of the 115 (89.6%) preintervention opioid prescriptions would not have adhered to the guidelines, whereas 39 of the 81 (48.1%) postintervention prescriptions did not adhere to the guidelines (P < 0.001). The proportion of refill prescriptions did not differ before and after intervention (P ¼ 0.44).Conclusions: The process of discussing postsurgical pain management and developing standardized opioid prescribing guidelines reduces overprescribing of opioids after ophthalmic surgery without increasing refill rates. Continued education is required to improve adherence to the prescribing guidelines further.

Change in Postoperative Opioid Prescribing Patterns for Oculoplastic and Orbital Procedures Associated With State Opioid Legislation

“…2 Postsurgical opioid prescription, even for a short course, can be associated with conversion to long-term use and dependence. 8,9,19 Ophthalmologists in general prescribe less opioids compared with the national mean among all prescribers. 10 According to recent surveys of ophthalmologists and oculoplastic specialists, 11,20 a significant proportion of the postoperative opioid prescriptions written by ophthalmologists are for oculoplastic and orbital procedures.…”

Impact of an Educational Intervention on the Opioid Knowledge and Prescribing Behaviors of Resident Physicians

“…Approaches to this have included legislative limits on prescription amounts for certain patient populations 2 and state-mandated use of Prescription Drug Monitoring Programs (PDMPs) to regulate opioid dispensing. 3 While recent studies have provided specialty-and procedure-speci c opioid prescribing recommendations based on patient consumption patterns and pain relief requirements, [4][5][6] no formal prescribing guidelines exist to eradicate the provider uncertainty that stems from the fear of undermanaging patient pain. 7 Additionally, medical school and residency program curricula dedicated to key opioid and pain management topics are underwhelming in the context of the severity of the opioid epidemic.…”

Opioid Stewardship in Surgical Ophthalmology: Implications for Public Health

“…US deaths from all sources of opioids had been increasing for many years, but by 2013, deaths increased at an even greater rate, such that by 2016, US annual deaths from opioids exceeded the number of deaths from automobile accidents or firearm incidents. 8 Efforts by surgical ophthalmologists to introduce opioid prescribing guidelines 9 and adhere to them can be important for each single patient. However, there is even greater opportunity to alter population health if ophthalmologic surgeons will use each episode of surgery as a teaching moment to educate patients and their immediate contacts (using face-to-face discussions, printed handouts, videos, and other means) about the risks of opioids and alternative methods for safely and effectively controlling postsurgical pain.…”