Fighting Back: Institutional Strategies to Combat the Opioid Epidemic: A Systematic Review

Lovecchio, Francis; Premkumar, Ajay; Stepan, Jeffrey G.; Albert, Todd J.

doi:10.1007/s11420-018-09662-y

Cited by 46 publications

(31 citation statements)

References 34 publications

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“…Possible modes of communication can be in the form of office telephone calls, electronic messaging, or other ways to contact clinicians. 190 If pain is not controlled or if there are side effects, patients and caregivers should be aware of how to communicate concerns with their clinician, and education on these options is beneficial.…”

Section: Key Action Statementsmentioning

confidence: 99%

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Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

Anne¹,

Mims

Tunkel

et al. 2021

Otolaryngol.--head neck surg.

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Objective Opioid use disorder (OUD), which includes the morbidity of dependence and mortality of overdose, has reached epidemic proportions in the United States. Overprescription of opioids can lead to chronic use and misuse, and unused narcotics after surgery can lead to their diversion. Research supports that most patients do not take all the prescribed opioids after surgery and that surgeons are the second largest prescribers of opioids in the United States. The introduction of opioids in those with OUD often begins with prescription opioids. Reducing the number of extra opioids available after surgery through smaller prescriptions, safe storage, and disposal should reduce the risk of opioid use disorder in otolaryngology patients and their families. Purpose The purpose of this specialty-specific guideline is to identify quality improvement opportunities in postoperative pain management of common otolaryngologic surgical procedures. These opportunities are communicated through clear actionable statements with explanation of the support in the literature, evaluation of the quality of the evidence, and recommendations on implementation. Employing these action statements should reduce the variation in care across the specialty and improve postoperative pain control while reducing risk of OUD. The target patients for the guideline are any patients treated for anticipated or reported pain within the first 30 days after undergoing common otolaryngologic procedures. The target audience of the guideline is otolaryngologists who perform surgery and clinicians who manage pain after surgical procedures. Outcomes to be considered include whether the patient has stopped using opioids, has disposed of unused opioids, and was satisfied with the pain management plan. The guideline addresses assessment of the patient for OUD risk factors, counseling on pain expectations, and identifying factors that can affect pain duration and/or severity. It also discusses the use of multimodal analgesia as first-line treatment and the responsible use of opioids. Last, safe disposal of unused opioids is discussed. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group. It is not a comprehensive guide on pain management in otolaryngologic procedures. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experiences and assessments of individual patients. Action Statements The guideline development group made strong recommendations for the following key action statements: (3A) prior to surgery, clinicians should identify risk factors for opioid use disorder when analgesia using opioids is anticipated; (6) clinicians should advocate for nonopioid medications as first-line management of pain after otolaryngologic surgery; (9) clinicians should recommend that patients (or their caregivers) store prescribed opioids securely and dispose of unused opioids through take-back programs or another accepted method. The guideline development group made recommendations for the following key action statements: (1) prior to surgery, clinicians should advise patients and others involved in the postoperative care about the expected duration and severity of pain; (2) prior to surgery, clinicians should gather information specific to the patient that modifies severity and/or duration of pain; (3B) in patients at risk for OUD, clinicians should evaluate the need to modify the analgesia plan; (4) clinicians should promote shared decision making by informing patients of the benefits and risks of postoperative pain treatments that include nonopioid analgesics, opioid analgesics, and nonpharmacologic interventions; (5) clinicians should develop a multimodal treatment plan for managing postoperative pain; (7) when treating postoperative pain with opioids, clinicians should limit therapy to the lowest effective dose and the shortest duration; (8A) clinicians should instruct patients and caregivers how to communicate if pain is not controlled or if medication side effects occur; (8B) clinicians should educate patients to stop opioids when pain is controlled with nonopioids and stop all analgesics when pain has resolved; (10) clinicians should inquire, within 30 days of surgery, whether the patient has stopped using opioids, has disposed of unused opioids, and was satisfied with the pain management plan.

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Section: Key Action Statementsmentioning

confidence: 99%

“…There is literature to support the provision of comprehensive education around opioid use, particularly through a multidisciplinary approach. 16,190-192 However, additional research regarding methods of opioid education and their outcomes would be beneficial.…”

Section: Key Action Statementsmentioning

confidence: 99%

Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

Anne¹,

Mims

Tunkel

et al. 2021

Otolaryngol.--head neck surg.

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show abstract

“…For patients, personalized educational material is called for, containing information on possible adverse reactions and the measures to take to avoid them, why the medication may be inappropriate, potential alternative treatment options, etc A 2018 randomized clinical trial found that 75% of sedative‐hypnotic drug users successfully completed a tapering protocol compared with 54% in a 2014 trial examining the effect of patient education alone on reducing inappropriate prescriptions . With orthopaedists being identified as overprescribing opioids, a systematic review by Lovecchio et al likewise discovered that formal patient education programmes were one of the most effective ways in reducing opioid use. However, a study from China has reported that only half of orthopaedic surgeons routinely perform risk assessment, medication education or timely follow‐up for patients with osteoporosis .…”

Section: Resultsmentioning

confidence: 99%

Impact of pharmaceutical care in the orthopaedic department

Xie

et al. 2019

J Clin Pharm Ther

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What is known and objective In the mid‐1960s, clinical pharmacy developed in the USA, and as the demand for pharmaceutical services continued to grow, their impact began to be taken seriously. However, the participation of clinical pharmacists as members of the multidisciplinary team in the orthopaedic department is still in its infancy, although its role in orthopaedics has not been defined. The object of this study was to identify and discuss the impact of pharmaceutical care in the orthopaedic department. Methods A literature search was conducted on MEDLINE, PubMed, Web of Science, the Cochrane Library and CNKI (China National Knowledge Infrastructure) for papers published between 1998 and 2019, using the keywords pharmacy, pharmacist, and medication or drug combined with orthopaedic. Other available resources were also used to identify relevant articles. Results and discussion Based on the available evidence in 74 articles, it was found that clinical pharmacists play an important role in all aspects of rational use of medications, medication review and reconciliation, monitoring adverse drug events, risk assessment, and medication education and counselling. In addition, clinical pharmacy services were developed to minimize medication errors, adverse drug events and medical costs, but clinical pharmacy is still in its early stages in orthopaedics. What is new and conclusion A multidisciplinary approach should be adopted in the orthopaedic department, as pharmacist interventions can be vital for promoting the safety, effectiveness and cost‐effectiveness of pharmacotherapy. Although pharmacists' contributions to orthopaedics are not yet fully recognized, pharmaceutical services can undoubtedly contribute to both clinical and societal outcomes.

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“…6,7 Prescribing fewer opioid tablets, providing preoperative education regarding appropriate opioid utilization, and using alternative pain control strategies have consistently been found to significantly reduce opioid utilization after surgery. [8][9][10][11] Supplemental forms of anesthesia before, during, and after certain arthroscopic procedures have also been shown to significantly reduce opioid consumption. 12,13 Given that only 4% of patients in the study required an inpatient admission, many of these ED visits may have been preventable.…”

Section: See Related Article On Page 1575mentioning

confidence: 99%

Editorial Commentary: Emergency Department Evaluation After Hip Arthroscopy Occurs More than Expected: Here’s Where Patient Education and a Multimodal Approach to Pain Management Can Be Helpful

Hartwell¹,

Tjong²

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Hip arthroscopy is known to be a relatively safe procedure with a limited and unique set complications and low hospital readmission rates. Many patients, however, may seek emergency department evaluation after surgery for postoperative pain or complaints unrelated to the most commonly cited complications, such as traction neuropraxia. It is important to recognize and understand the reasons why patients seek medical care after surgery because many of these encounters may be preventable with optimization of perioperative multimodal pain control regimens and proper patient education regarding their expected postoperative course. Patients with barriers to health care access, such as Medicare and Medicaid patients, may be at higher risk for emergency department evaluation of their problems after surgery and clinicians should consider providing additional counseling to these patients regarding when and how to seek medical evaluation after surgery.

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Fighting Back: Institutional Strategies to Combat the Opioid Epidemic: A Systematic Review

Cited by 46 publications

References 34 publications

Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

Impact of pharmaceutical care in the orthopaedic department

Editorial Commentary: Emergency Department Evaluation After Hip Arthroscopy Occurs More than Expected: Here’s Where Patient Education and a Multimodal Approach to Pain Management Can Be Helpful

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