Introduction: Diversion of excess prescription opioids contributes to the opioid epidemic. We sought to describe and study the impact of a comprehensive departmental initiative to decrease opioid prescribing in surgery. Methods: A multispecialty multidisciplinary initiative was designed to change the culture of postoperative opioid prescribing, including: consensus-built opioid guidelines for 42 procedures from 11 specialties, provider-focused posters displayed in all surgical units, patient opioid/pain brochures setting expectations, and educational seminars to residents, advanced practice providers, residents and nurses. Pre- (April 2016–March 2017) versu post-initiative (April 2017–May 2018) analyses of opioid prescribing at discharge [median oral morphine equivalent (OME)] were performed at the specialty, prescriber, patient, and procedure levels. Refill prescriptions within 3 months were also studied. Results: A total of 23,298 patients were included (11,983 pre-; 11,315 post-initiative). Post-initiative, the median OME significantly decreased for 10 specialties (all P values < 0.001), the percentage of patients discharged without opioids increased from 35.7% to 52.5% (P < 0.001), and there was no change in opioids refills (0.07% vs 0.08%, P = 0.9). Similar significant decreases in OME were observed when the analyses were performed at the provider and individual procedure levels. Patient-level analyses showed that the preinitiative race/sex disparities in opioid-prescribing disappeared post-initiative. Conclusion: We describe a comprehensive multi-specialty intervention that successfully reduced prescribed opioids without increase in refills and decreased sex/race prescription disparities.

Aging families encounter non-normative and age-related challenges that often cause stress on the family system. The concept of family resilience provides a relevant strength-based perspective for recognizing the multigenerational transitions and challenges encountered by families as they age. Based on the existing family resilience and successful aging literature we outline and provide potential clinical direction for three key constructs (flexibility, social support, and spirituality/religiosity) which have the largest supportive body of evidence in the aging and resilience literature. Recognizing the characteristics that contribute to aging well through a family resilience lens lays the foundation for strength-based intervention with aging families.During the last 100 years, the human lifespan has nearly doubled. Currently one out every eight Americans is over 65 years of age and this number is expected to grow exponentially over the next two decades (Moody, 2005). While there is vast heterogeneity in aging, the nature of adversities encountered by older adults and their families are different

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