Postoperative opioid prescribing practices in US adult trauma patients: A systematic review

Rowe, Scott; Zagales, Israel; Fanfan, Dino; Gargano, Toria; Meneses, Evander; Awan, Muhammad Usman; Zagales, Ruth; McKenney, Mark; Elkbuli, Adel

doi:10.1097/ta.0000000000003341

Cited by 8 publications

(1 citation statement)

References 38 publications

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“…A systematic review encapsulating over 30,000 trauma patients in the U.S. found that opioid prescriptions are more common following trauma surgery ( Rowe et al, 2022 ), despite the finding that patients receiving opioids were more likely to report decreased satisfaction with pain relief, compared to other analgesic methods ( Bot et al, 2014 ). Prolonged opioid use has been shown to be particularly elevated in trauma settings ( Mohamadi et al, 2018 ), with 35% of patients continuing to use opioids 4 months after traumatic injury ( Rosenbloom et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Feasibility of implementing a screening tool for risk of opioid misuse in a trauma surgical population

Baltes,

Horton,

Trevino

et al. 2024

Implementation Research and Practice

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Background As the opioid crisis continues to affect communities across the United States, new interventions for screening and prevention are needed to mitigate its impact. Mental health diagnoses have been identified as a risk factor for opioid misuse, and surgical populations and injury survivors are at high risk for prolonged opioid use and misuse. This study investigated the implementation of a novel opioid risk screening tool that incorporated putative risk factors from a recent study in four trauma units across Wisconsin. Method The screening tool was implemented across a 6-month period at four sites. Data was collected via monthly meeting notes and “Plan, Do, Study, Act” (PDSA) forms. Following implementation, focus groups reflected on the facilitators and barriers to implementation. Meeting notes, PDSA forms, and focus group data were analyzed using the consolidated framework for implementation research, followed by thematic analyses, to generate themes surrounding the facilitators and barriers to implementing an opioid misuse screener. Results Implementation facilitators included ensuring patient understanding of the screener, minimizing staff burden from screening, and educating staff to encourage engagement. Barriers included infrastructure limitations that prevented seamless administration of the screener within current workflows, overlap of the screener with existing measures, and lack of guidance surrounding treatment options corresponding to risk. Recommended solutions to address barriers include careful timing of screener administration, accommodating workflows, integration of the screening tool within the electronic health record, and evidence-based interventions guided by screener results. Conclusion Four trauma centers across Wisconsin successfully implemented a pilot opioid misuse screening tool. Trauma providers and unit staff members believe that this tool would be a beneficial addition to their repertoire if their recommendations were adopted. Future research should refine opioid misuse risk factors and ensure screening items are well-validated with psychometric research supporting treatment responses to screener-indicated risk categories.

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