Can educational videos reduce opioid consumption in trauma inpatients? A cluster-randomized pilot study

Abstract

BACKGROUND:Opioids are often used to treat pain after traumatic injury, but patient education on safe use of opioids is not standard. To address this gap, we created a video-based opioid education program for patients. We hypothesized that video viewing would lead to a decrease in overall opioid use and morphine equivalent doses (MEDs) on their penultimate hospital day. Our secondary aim was to study barriers to video implementation. METHODS:We performed a prospective pragmatic cluster-randomized pilot study of video education for trauma floor patients. One of two equivalent trauma floors was selected as the intervention group; patients were equally likely to be admitted to either floor. Nursing staff were to show videos to English-speaking or Spanish-literate patients within 1 day of floor arrival, excluding patients with Glasgow Coma Scale score less than 15. Opioid use and MEDs taken on the day before discharge were compared. Intention to treat (ITT) (intervention vs. control) and per-protocol groups (video viewers vs. nonviewers) were compared (α = 0.05). Protocol compliance was also assessed. RESULTS:In intention to treat analysis, there was no difference in percent of patients using opioids or MEDs on the day before discharge. In per-protocol analysis, there was no different in percent of patients using opioids on the day before discharge. However, video viewers still on opioids took significantly fewer MEDs than patients who did not see the video (26 vs. 38, p < 0.05). Protocol compliance was poor; only 46% of the intervention group saw the videos. CONCLUSION:Video-based education did not reduce inpatient opioid consumption, although there may be benefits in specific subgroups. Implementation was hindered by staffing and workflow limitations, and staff bias may have limited the effect of randomization. We must continue to establish effective methods to educate patients about safe pain management and translate these into standard practices.

Outcomes in deprescribing implementation trials and compliance with expert recommendations: a systematic review

“…The 36 included studies took place in 16 different countries: 19 (52.8%) in Europe [ 22 , 25 , 28 – 33 , 35 , 36 , 38 , 41 , 46 , 48 , 52 – 54 , 56 , 57 ], 11 (30.6%) in North America [ 23 , 24 , 26 , 27 , 34 , 39 , 43 , 44 , 49 – 51 ], four (11.1%) in Asia [ 40 , 42 , 47 , 55 ], and two (5.6%) in Australia [ 37 , 45 ]. The general characteristics of the selected studies are presented in Table 1 .…”

“…[ 49 ] 2017 USA Primary care NA Opioids Patient information + motivational interviewing with patient 8.5 Tannenbaum C. [ 50 ] 2014 Canada Primary care 65 BZD Patient empowerment intervention 6 Tseng ES. [ 51 ] 2021 USA Hospital, trauma unit NA Opioid Patient information 1 Van der Meer HG. [ 52 ] 2018 Netherlands Primary care 65 Anticholinergic and sedative drugs Medication drug review (pharmacist) 3 Vicens C. [ 53 ] 2014 Spain Primary care NA BZD GP information 12 Vicens C. [ 54 ] 2016 Spain Primary care NA BZD GP information 36 Wong APY.…”

“…In 18 studies (50%), the patients were over 65 years of age [ 23 – 25 , 27 , 28 , 30 , 32 , 33 , 36 – 38 , 42 , 44 – 46 , 50 , 52 , 55 ]. Regarding the setting, 13 studies (36.1%) took place in primary care [ 23 , 27 , 30 , 35 , 43 , 44 , 46 , 49 , 50 , 52 – 54 , 57 ], 12 (33.3%) in nursing homes [ 24 , 28 , 29 , 31 , 32 , 36 , 38 , 41 , 42 , 45 , 48 , 56 ], seven (19.4%) in hospitals (emergency department, surgery unit, intensive care unit, trauma unit) [ 25 , 26 , 33 , 34 , 37 , 39 , 51 ], two (5.6%) in a rehabilitation hospital [ 40 , 55 ], one (2.8%) in an outpatient department of psychiatry [ 47 ], and one (2.8%) in subacute medical outpatient [ 22 ]. The follow-up period ranged from one to 36 months, with 13 studies (36.1%) with a duration of follow-up of 12 months [ 22 , 23 , 25 , 27 , 29 , 30 , 33 , 35 , 39 , 42 , 45 , 53 , …”

Educational Intervention for Management of Acute Trauma Pain: A Proof-of-Concept Study in Post-surgical Trauma Patients

“…As hypothesized, after the educational intervention, we observed reductions in prescribed opioids directly related to the shift in attitudes toward opioids. In addition, another recent pilot study employed video-based education on opioid safety for patients after traumatic injury ( 21 ). The authors found that among the patients who were continuously using opioids throughout the study, the group who watched the educational video had lower MME than the group who did not receive an educational information ( 21 ).…”

“…This study adopted an educational intervention to change expectations and perceptions toward opioids safety. Unlike a recent study using pre-recorded video education with a low participant compliance ( 21 ), the educational intervention in the current study was conducted by trained research staff, ensuring interactive educational procedures rather than passive learning. Moreover, the research staff was independent of the clinical treating team of nurses and physicians, minimizing recruitment and other biases.…”