P060: IMPLEMENTING SAFER OPIOID PRESCRIBING: ANALYSIS OF DATA AND INTERVENTIONS IN A LARGE MEDICAL CENTER
Evan Peskin, MD, MBA1, Astorini Christiana2, Maksym Doroshenko, MD1; 1Jackson Memorial Hospital / University of Miami / Miami VA Medical Center, 2Miami VA Medical Center
Introduction: The opioid epidemic took over 42,000 American lives in 2016. National attention is focused on combatting this problem on all levels. Surgical patients represent a population at risk for opioid overuse and prescribing practitioners should be aware of their role in this epidemic. Despite the evidence that prescriptions can contribute to unnecessary and long-term use of narcotics, there is a lack of guidelines and standards for prescribing narcotics after surgery. The purpose of this study was to investigate the number of outpatient narcotic prescriptions at the Miami VA for opioid-naïve surgical patients and whether patients require the amount of opioids prescribed to them.
Methods: Investigators obtained baseline information regarding narcotic prescriptions issued last year at the Miami VA for surgical patients. The study utilized Shewhart cycle for continuous improvement and included 151 opioid-naive patients undergoing general or orthopedic inpatient and outpatient surgeries who received outpatient narcotics. Average dosages were calculated using morphine equivalents (MED). Researchers then performed telephone surveys to assess the outpatient use of analgesics. Additionally, patients were asked whether they were educated on the use of narcotics and potential side-effects. Resulting data was presented to surgical teams and further improvement monitored.
Results: Average amount of opioids prescribed for comparable surgical procedures from 10/2016 to 7/2017 was 145 MED. After starting the Shewhart cycle, a total of 151 patients have been surveyed, including 95 general surgery patients and 56 orthopedic patients. Average MED of opioids prescribed at discharge in the last phase of study cycle was 82 MED (43% decrease) among surgical patients and 279 MED among orthopedic patients. Of that, only 54% of prescribed opioids were used by surgical patients and 59% by orthopedic patients. Thirty six out of 151 patients (23%) took all the prescribed narcotics. Sixty five of 151 (43%) were instructed to use non-opioid pain medications. Eighty three (55%) were counseled on possible side-effects of narcotics. Average amount of opioid analgesics used to effectively control acute pain after inguinal/ umbilical hernia repair (n=47) was 48 MED (SD - 37 MED), small soft tissue excisions (n=21) was 30 MED (SD – 30 MED), cholecystectomy (n=7) was 30 MED (SD - 31 MED) and further data is being collected.
Discussion: Surgical patients at the Miami VA may receive excessive narcotics as an outpatient. An outpatient prescription protocol could be modeled and order sets created with recommended amount of analgesics implemented through the current electronic medical record system. More precise predictions could be derived from descriptive statistics of amounts of opioids used to effectively control post-op pain after common surgical procedures.