Opioid Prescribing Practices and Quality Improvements Within an Outpatient Orthopedic Practice

Abstract

BackgroundDuring the last several decades, the opioid epidemic throughout the United States has been recognized as an increasing problem. The aim of this study was to identify and implement processes throughout a single private orthopedic practice and managed ambulatory surgery centers to reduce opioid prescription pill quantity and strength, while also reducing consumption. MethodologyA baseline assessment along with the development of four separate phases was implemented. Data collection included type, dosage, and quantity of opioids prescribed after elective outpatient procedures as well as patient interviews/surveys within two weeks after surgery. Quality improvement implementation included: (a) presentations on opioid prescribing at an individual physician level, (b) internal prescription guidelines, (c) required Prescription Monitoring Program registration, and (d) patient narcotic education pamphlets after surgery. The average opioids prescribed and consumed were compared between different time points. ResultsAnalysis revealed a highly statistically significant decrease in both pills and morphine equivalent units (MEUs) prescribed (p < 0.001, p < 0.001) between the baseline assessment and four subsequent phases, as well as consumed (p < 0.001, p < 0.001) between phases one through four. Even though patients were consuming less pills and MEUs than they were prescribed on average across all phases, overall pain levels increased between phases one through four (p < 0.001), and overall satisfaction of pain control decreased between phases two through four (p < 0.001). ConclusionsOver a 24-month time frame, a single private orthopedic practice set a goal of reducing prescribing habits and with successful implementation of various measures, a significant reduction in opioids prescribed and consumed was accomplished. Interestingly, pain level and satisfaction of pain control worsened even though patients were continuing to be prescribed more opioids on average than they were consuming. Therefore, it may be normal to see these results when attempting to set the expectation for some level of pain and reduced consumption of opioid medications post-operatively. Overall, these results can be useful to healthcare administrators and surgeons looking for ways to combat the opioid epidemic.

The impact of the Florida law HB21 on opioid prescribing patterns after spine surgery

“…Spine patients in particular are at high risk for chronic opioid use, with studies showing upwards of 40% of patients with a chief complaint of low back pain received prescription opioids within three months of presentation [11] . While narcotic prescriptions can lead to addiction and diversion, they are also associated with higher rates of nonunion, infection, and morbidity and mortality [ 12 , 13 ].…”