Introduction of an Analgesia Prescription Guideline Can Reduce Unused Opioids After Cardiac Surgery: A Before and After Cohort Study

Pena, Joseph J.; Chen, Chung-Jen; Clifford, Hugo; Xue, Zenghui; Wang, Shuang; Argenziano, Michael; Landau, Ruth; Meng, Marie-Louise

doi:10.1053/j.jvca.2020.12.021

Cited by 9 publications

(16 citation statements)

References 17 publications

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“…When considering reduced opioid quantities at discharge, a common concern among surgeons is an increase in office calls from patients requesting opioid prescription refills. Ample evidence supports that a large portion of opioids prescribed at discharge after surgery go unused, however, and initiatives to limit discharge opioid prescription quantities have successfully reduced opioid exposure without adversely affecting pain management or refill requests [42,[44][45][46]93,473,476,[481][482][483][484][485][486][487][488][489][490]. Maximizing nonopioid therapies and developing patient-specific plans are essential to the success and safety of such practice changes.…”

Section: Discharge Phasementioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

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Section: Discharge Phasementioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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“…47 Three studies used the amount of opioids consumed during the 24-48 hours prior to discharge to guide prescription quantities. 32,43,44 All of these pre-post studies showed a relative reduction in both the proportion of patients discharged with an opioid (56% decrease), and the amount of opioids prescribed (31-56% decrease).…”

Section: Guidelines and Protocols Implemented To Guide Prescribingmentioning

confidence: 98%

“…The studies included were conducted in the United States of America (n=34), [15][16][17][18][19][20][21][22][23][24][25][26][27][28][30][31][32][33][35][36][37][38][39][40][41][43][44][45][47][48][49][50]55,56 Australia (n=8) 14,29,34,42,[51][52][53][54] and the United Kingdom (n=1). 46 There were 16 studies which employed a multifaceted intervention, 16,18,24,25,31,37,38,42,45,46,49,[50]…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Thirteen studies assessed the implementation of protocols and guidelines in guiding opioid prescribing upon hospital discharge. 17,21,23,27,30,32,36,40,41,43,44,47,53 These guidelines included recommendations for multimodal analgesia, procedure-specific prescribing, patient-specific prescribing, and general guidelines.…”

Section: Guidelines and Protocols Implemented To Guide Prescribingmentioning

confidence: 99%

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Effectiveness of organisational interventions on the appropriate use of opioids for non-cancer pain upon hospital discharge: A systematic review

Phinn

Liu²,

Patanwala

et al. 2022

Preprint

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Aim: To summarise the effectiveness of organisational interventions on appropriate opioid use for non-cancer pain upon hospital discharge. Methods: A systematic search was conducted on six electronic databases by two independent reviewers. We included original research articles reporting on quantitative outcomes of organisational interventions targeting appropriate opioid use on hospital discharge. Quality assessment was performed by two independent reviewers. The protocol for this review was prospectively registered on PROSPERO (ID: CRD42020156104). Results: Out of 173 full texts assessed for eligibility, 43 were included in this review. The majority of studies had a moderate to serious risk of bias (33 out of 43). Most of the studies implemented a multifaceted organisational intervention (16 studies). Other interventions included guideline implementation, prescriber education and default opioid prescribing quantity changes in electronic medical records. Multiple studies found that the dissemination of patient-specific and procedure-specific guidelines reduced the quantity of opioids prescribed by 44-57%. Prescriber education provided with feedback was implemented in four studies and resulted in a 33-44% decrease in prescribing rates. Lowering the default quantities in the electronic medical records produced a 40% decrease in opioids prescribed in one study. Conclusion: Guideline implementation, prescriber education and default opioid prescribing quantity changes all appear effective in improving the appropriate use of opioids on hospital discharge. However, the extent of reduction of opioid prescribing upon hospital discharge after the implementation of multifaceted intervention strategies appears similar to that of simpler interventions which require fewer resources.

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“…In this issue of the Journal, Pena et al presented data principally from the long-standing public health emergency of opioid deaths in the United States. 1 This partially was fueled by the tripling of opioid prescriptions since 1999, 2 with more than 40% of all overdose deaths involving a prescription opioid, 3 but the specific role of medication initiated during hospital care remains unclear.…”

Section: Churchill Would Have Approvedmentioning

confidence: 99%