Opioid prescribing improvement in orthopaedic specialty unit in a tertiary hospital: a retrospective audit of hospital discharge data pre‐ and post‐intervention for better opioid prescribing practice

Abstract

Background: This study aimed to investigate the effects of an intervention focusing on better opioid prescription practice in a tertiary metropolitan hospital orthopaedic unit. Methods: Following a previous audit of opioid prescribing in the orthopaedics unit, an intervention comprising the (i) Expert Advisory Group oversight of opioid prescribing, (ii) development of a prescription opioid guideline for various hospital contexts and (iii) a series of education sessions was undertaken to improve opioid prescription practice. A reaudit was subsequently carried out to determine whether the intervention had had an impact on the previously audited orthopaedic unit. Results: Each audit period was 6 months. There were 281 orthopaedic patients in the original audit (). In both audits, a high proportion of patients were discharged to the community on opioids, 82.2% (n = 231) pre-intervention and 79.6% (n = 230) post-intervention. Statistically significant differences in opioid prescribing were found between audits, including: a reduction in the number of patients discharged on combination opioids from 71.4% to 45.7% (P < 0.001), a reduction in the provision of full pharmaceutical quantities of opioid on discharge from 29.4% to 6.1% (P < 0.001) and an increase in opioid weaning plans included in discharge summaries from 6.9% to 87.4% (P < 0.001). Conclusion: Raised awareness across the organization and education for staff more than halved the post-operative opioid prescription levels. This highlights the capacity for change in hospitals and the ability to work towards safer prescribing of post-operative opioid therapy.

A Rapid Review of the Impact of Systems-Level Policies and Interventions on Population-Level Outcomes Related to the Opioid Epidemic, United States and Canada, 2014-2018

“…[107][108][109][110][111] The 3 recent studies on educational interventions found a decrease in opioid prescribing after implementation of an educational intervention for patients 112 and a combined guidelines/educational intervention for health care providers. 113,114…”

Developing a framework for implementing opioid stewardship programmes in Australian hospital settings

“…However, they are frequently prescribed in quantities in excess of need, 7,8 contributing to the increase in prescription opioid reservoir in the community 8 and to long‐term use and subsequent harm 9 . In addition, de‐escalation of hospital‐initiated opioid treatment in the early days after discharge is hampered by suboptimal clinical handover to primary care 10 …”

“…There has been a growing interest in improving opioid prescribing in hospital settings, with early focus on decreasing the volume of prescriptions, the quantity provided and improving discharge communication 10–14 . However, these strategies vary widely and are often limited to emergency or surgical settings 10–14 …”

“…9 In addition, de-escalation of hospital-initiated opioid treatment in the early days after discharge is hampered by suboptimal clinical handover to primary care. 10 There has been a growing interest in improving opioid prescribing in hospital settings, with early focus on decreasing the volume of prescriptions, the quantity provided and improving discharge communication. [10][11][12][13][14] However, these strategies vary widely and are often limited to emergency or surgical settings.…”

“…10 There has been a growing interest in improving opioid prescribing in hospital settings, with early focus on decreasing the volume of prescriptions, the quantity provided and improving discharge communication. [10][11][12][13][14] However, these strategies vary widely and are often limited to emergency or surgical settings. [10][11][12][13][14] There has also been growing interest in repurposing principles of antimicrobial stewardship programmes for opioid management.…”