Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
J Bone Joint Surg Am. 2018 Oct 3;100(19):1698-1703. doi: 10.2106/JBJS.17.01307.
Opioid-prescribing patterns have been implicated as a contributing factor to the opioid epidemic, yet few evidence-based guidelines exist to assist health-care providers in assessing and possibly modifying their prescribing practices.
Five orthopaedic hand surgeons at a level-I trauma center developed a postoperative prescribing guideline for 25 common hand and upper-extremity outpatient procedures, which were delineated into 5 tiers. Postoperative opioid prescriptions in a 3-month period after implementation of the protocol were compared with those from a 3-month period before implementation of the protocol.
There were 231 patients in the pre-implementation group and 287 patients in the post-implementation group. Each individual opioid protocol tier showed a significant decrease in the mean morphine milligram equivalents (MME) prescribed, ranging from a minimum decrease of 97.8% to a maximum decrease of 176.0%. After implementation, adherence to protocol was achieved in 55.1% of patients; the MME amounts prescribed were below protocol for 28.6% and above for 16.4%. The number of additional opioid prescriptions in the 1-month postoperative period was significantly less in the post-implementation group than in the pre-implementation group (p < 0.001). The total number of pills prescribed was reduced by a theoretical equivalent of over three thousand 5-mg oxycodone pills for the 287 patients in the 3-month period.
By utilizing a simple consensus protocol, we have demonstrated success diminishing the number of opioids prescribed without leading to an increase in the number of secondary prescriptions written by our providers. These findings are encouraging and suggest that fewer opioids were left in the possession of patients, leaving fewer pills vulnerable to misuse, abuse, and diversion.
阿片类药物的处方模式被认为是阿片类药物流行的一个促成因素，但几乎没有循证指南来帮助医疗保健提供者评估和可能改变他们的处方实践。
一家一级创伤中心的五名骨科手部外科医生为 25 种常见的手部和上肢门诊手术制定了术后处方指南，这些手术被分为 5 个等级。在实施该方案后的 3 个月内，比较术后阿片类药物处方与实施该方案前的 3 个月内的处方。
实施前组有 231 例患者，实施后组有 287 例患者。每个单独的阿片类药物方案等级显示出规定的平均吗啡毫克当量（MME）显著减少，范围从最小减少 97.8%到最大减少 176.0%。实施后，55.1%的患者遵守了方案；28.6%的患者处方 MME 量低于方案，16.4%的患者处方 MME 量高于方案。实施后组在术后 1 个月内额外开具阿片类药物处方的数量明显少于实施前组（p < 0.001）。在 3 个月期间，为 287 名患者开具的药丸总数减少了理论上超过 3000 片 5 毫克羟考酮药丸。
通过使用简单的共识方案，我们成功地减少了阿片类药物的处方数量，而没有导致我们的提供者开具更多的二线处方。这些发现令人鼓舞，表明患者手中剩余的阿片类药物数量减少，减少了药丸被滥用、滥用和转移的风险。
