Surgical interns: Preparedness for opioid prescribing before and after a training intervention

Nooromid, Michael J.; Mansukhani, Neel A.; Deschner, Benjamin W.; Moradian, Simon; Issa, Nabil; Ho, Karen J.; Stulberg, Jonah J.

doi:10.1016/j.amjsurg.2017.11.017

Cited by 40 publications

(22 citation statements)

References 13 publications

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“…Single-institution studies educating trainees at academic institutions have led to decreases in opioid prescribing. [20][21][22][23] Second, lowering the default quantities for opioids set in electronic medical record systems may also change prescriber behaviors. 24 Third, preoperative screening may identify patients at risk of both difficult pain control and chronic opioid use after surgery.…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…13 All residents and advanced practice providers also received a formal training program regarding the need for stewardship in the prescribing of opioids. 14 The nurse manager and clinical educator in the clinic held training sessions for the nurses, medical assistants, and other staff involved in the patient education and the process of retrieval/disposal of unused opioids. In addition, the nursing leadership provided targeted education to individual staff members who did not provide consistent education to the patient or document their discussion with patients appropriately.…”

Section: Interventionmentioning

confidence: 99%

Preoperative patient education and patient preparedness are associated with less postoperative use of opioids

Khorfan

Shallcross

et al. 2020

Surgery

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Background: Because many patients are first exposed to opioids after general surgery procedures, surgical stewardship for the use of opioids is critical in addressing the opioid crisis. We developed a multicomponent opioid reduction program to minimize the use of opioids after surgery. Our objectives were to assess patient exposure to the intervention and to investigate the association with postoperative use and disposal of opioids. Methods: We implemented a multi-component intervention, including patient education, the settings of expectations, the education of the providers, and an in-clinic disposal box in our large, academic, general surgery clinic. From April to December 2018, patients were surveyed by phone 30 to 60 days after their operation regarding their experience with postoperative pain management. The association between patient education and preparedness to manage pain was assessed using c 2 tests. Education, preparedness, and clinical factors were evaluated for association with quantity of pills used using ANOVA and multivariable linear regression. Results: Of the 389 eligible patients, 112 responded to the survey (28.8%). Patients receiving both pre and postoperative education were more likely to feel prepared to manage pain than those who only received the education pre or postoperatively (91% vs 68%, P ¼ .01). Patients who felt prepared to manage their pain used 9.1 fewer pills on average than those who did not (P ¼ .01). Fourteen patients (24%) with excess pills disposed of them. Preoperative education was associated with disposal of excess pills (30% vs 0%, P < .05). Conclusion: Exposure to clinic-based interventions, particularly preoperatively, can increase patient preparedness to manage postoperative pain and decrease the quantity of opioids used. Additional strategies are needed to increase appropriate disposal of unused opioids.

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“…International literature suggests that suboptimal practice results from poor knowledge, confidence and accuracy in opioid prescribing . Prescriber education was therefore key to our strategy to address better opioid prescribing practice.…”

Section: Discussionmentioning

confidence: 99%

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

Stanley

Jackson

Norman

et al. 2019

ANZ Journal of Surgery

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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.

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Surgical interns: Preparedness for opioid prescribing before and after a training intervention

Abstract: Most surgical interns were not trained in prescribing narcotics in medical school. Improved pain management curriculum is necessary to assure safe and consistent opioid prescriptions.

Cited by 40 publications

References 13 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?

Preoperative patient education and patient preparedness are associated with less postoperative use of opioids

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

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