Empowering Post-Surgical Patients to Improve Opioid Disposal: A Before and After Quality Improvement Study

Hasak, Jessica M.; Bettlach, Carrie Roth; Santosa, Katherine B.; Larson, Ellen L.; Stroud, Jean; Mackinnon, Susan E.

doi:10.1016/j.jamcollsurg.2017.11.023

Cited by 111 publications

(94 citation statements)

References 22 publications

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“…[3][4][5][6][7][8] Interventions based on patient education have shown mixed effects with some studies showing no impact on appropriate disposal rates 9 and others showing positive benefits. 2,10,11 We conducted a single-institution prospective observational pilot study to determine 1) how postsurgical patients manage leftover opioids and 2) if the distribution of free home disposal packets and educational handouts increased the likelihood that patients would appropriately dispose of their leftover opioids. We hypothesized that the distribution of an opioid home disposal packet would increase patient-reported disposal intention.…”

Section: Introductionmentioning

confidence: 99%

Home Disposal Kits for Leftover Opioid Medications After Surgery: Do They Work?

Stokes

Kim

Jacobs

et al. 2020

Journal of Surgical Research

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Section: Introductionmentioning

confidence: 99%

Home Disposal Kits for Leftover Opioid Medications After Surgery: Do They Work?

Stokes

Kim

Jacobs

et al. 2020

Journal of Surgical Research

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“…Importantly, previous studies have demonstrated that many patients inappropriately store and dispose of opioids, which can contribute to the diversion of unused opioids. 6,26 Third, given that the phone call was timed for days 7 to 10, when some patients were still routinely using opioids for pain control, the opioid requirements in the 30 day postoperative time period may have been higher than reported.…”

mentioning

confidence: 99%

Surgeon perception versus reality: Opioid use after breast cancer surgery

Park

Kyrish

Terrell

et al. 2019

Journal of Surgical Oncology

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Background Few guidelines exist for an opioid prescription after breast surgical oncology (BSO) procedures. We sought to characterize opioid prescribing and use patterns by surgery type. Methods Patients (n = 332) undergoing BSO procedure were surveyed one week postoperatively for opioid use. The surgeons were surveyed about pain management preferences surgery type. CPT codes were collected for 2017 to calculate the amount of opioids used by surgery type relative to surgeon preference. Results Mean oral morphine equivalent (OME) preferred prescription for surgeons who did not tailor prescriptions by surgery type (n = 7, group A) was 177, whereas for those who did tailor (n = 10, group B) varied from 137 to 257 OME. There was a significant difference in opioid use by surgery type: 32 OME for segmental mastectomy (SM) ± sentinel lymph node dissection (SLND), 63 for SM + axillary lymph node dissection (ALND), 76 for total mastectomy (TM) ± SLND, 115 for TM + ALND (P < 0.001). Considering the type of surgeries performed group A prescribers would have 229190 unused OME and group B would have 230826 in 1 year. Conclusion Wide variation in opioid use by BSO procedure type was noted with substantial unused OME regardless ofprescribing preference. Evidence‐based guidelines are needed to tailor analgesic prescriptions according to the need.

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“…14,15 Physician and patient education, smaller opioid prescriptions, non-opioid analgesic medications and improvement of appropriate opioid disposal have all been proposed recently as strategies to combat the opioid crisis. 14,[16][17][18] At London Health Sciences Centre, the Division of General Surgery identified opioid prescribing for acute pain as a priority area for improvement based on the 2017 Health Canada-Joint Statement of Action to Address the Opioid Crisis. 19 We designed the Standardization of Outpatient Procedure Narcotics (STOP Narcotics) initiative to standardize pain management approaches, with the objective of reducing excessive postoperative opioid prescriptions, and adequately controlling postoperative pain in outpatient general surgical procedures.…”

mentioning

confidence: 99%

Standardization of Outpatient Procedure (STOP) Narcotics: A Prospective Non-Inferiority Study to Reduce Opioid Use in Outpatient General Surgical Procedures

Hartford

Koughnett

Murphy

et al. 2019

Journal of the American College of Surgeons

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BACKGROUND: There has been a dramatic rise in opioid abuse, and diversion of excess, unused prescriptions is a major contributor. We assess the impact of implementing a new standardized pain care bundle to reduce postoperative opioids in outpatient general surgical procedures. STUDY DESIGN: This study was designed to demonstrate non-inferiority for the primary end point: patientreported average pain in the first 7 postoperative days. We prospectively evaluated 224 patients who underwent laparoscopic cholecystectomy or open hernia repair (inguinal, umbilical) pre-intervention to 192 patients post-intervention. We implemented a multimodal intra-and postoperative analgesic bundle, including promoting co-analgesia, opioid-reduced prescriptions, and patient education designed to clarify patient expectations. Patients completed a brief pain inventory at their first postoperative visit. Groups were compared using chi-square test, Mann-Whitney U test, and independent samples t-test, where appropriate. RESULTS: No difference was seen in average postoperative pain scores in the pre-vs post-intervention groups (2.3 vs 2.1 of 10; p ¼ 0.12). The reported quality of pain control improved postintervention (good/very good pain control in 69% vs 85%; p < 0.001). The median total morphine equivalents for prescriptions filled in the post-intervention group were significantly less (100; interquartile range 75 to 116 pre-intervention vs 50; interquartile range 50 to 50 post-intervention; p < 0.001). Only 78 of 172 (45%) patients filled their opioid prescription in the post-intervention group (p < 0.001), with no significant difference in prescription renewals (3.5% pre-intervention vs 2.6% post-intervention; p ¼ 0.62). CONCLUSIONS: For outpatient open hernia repair and cholecystectomy, a standardized pain care bundle decreased opioid prescribing significantly and frequently eliminated opioid use, while adequately treating postoperative pain and improving patient satisfaction.

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Empowering Post-Surgical Patients to Improve Opioid Disposal: A Before and After Quality Improvement Study

Abstract: Dissemination of the educational brochure improved disposal of unused opioids after surgery. This low-cost, easily implemented intervention can improve disposal of unused opioids and ultimately, decrease the amount of excess opioids circulating in our communities.

Cited by 111 publications

References 22 publications

Home Disposal Kits for Leftover Opioid Medications After Surgery: Do They Work?

Home Disposal Kits for Leftover Opioid Medications After Surgery: Do They Work?

Surgeon perception versus reality: Opioid use after breast cancer surgery

Standardization of Outpatient Procedure (STOP) Narcotics: A Prospective Non-Inferiority Study to Reduce Opioid Use in Outpatient General Surgical Procedures

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