Division of Surgical Oncology, Medical University of South Carolina, Charleston, South Carolina.
Division of Surgical Oncology, Medical University of South Carolina, Charleston, South Carolina.
J Surg Res. 2021 Jan;257:597-604. doi: 10.1016/j.jss.2020.06.039. Epub 2020 Sep 12.
Standardized prescribing practices are recommended to decrease opioid abuse, however, data regarding the handling and disposal of leftover narcotics are lacking. This quality improvement project and analysis evaluated implementation of standardized prescribing, opioid education, and a narcotic disposal system.
This initiative was implemented over a 1-y period among patients who underwent breast surgery. The project included the following: 1) implementation of standardized prescribing, 2) voluntary and anonymous survey analysis, and 3) preoperative education regarding risks of opioids, charcoal disposal bag distribution, and follow-up survey to assess use and use of intervention.
Preintervention surveys were completed by 53 patients, and 60% (n = 32) underwent lumpectomy. Narcotic prescriptions were filled by 90%; median number of pills taken was 3 (range 0-24), however 93% felt that a non-narcotic was more effective. Eighty three percentage of patients had unused pills, and 58% kept these pills in an unlocked cabinet. Postintervention surveys were completed by 66 patients, and 48% (n = 32) underwent lumpectomy. Narcotic prescriptions were filled by 88%, median number of pills taken was 4 (range 0-40), and 89% of patients had pills leftover. Sixty seven percentage of patients found the education handout useful and charcoal bag use was reported by 37% (n = 17). The median postoperative pain control satisfaction score was 4.5 (5-point Likert scale, 1 = very dissatisfied, 5 = very satisfied) on both preintervention and postintervention surveys.
This study, which included standardized prescribing parameters, opioid education, and implementation of a disposal method, was found to be feasible, beneficial, and did not compromise postoperative pain control.
为了减少阿片类药物滥用，建议采用标准化的处方实践，但关于剩余麻醉药品的处理和处置的数据却很缺乏。本质量改进项目和分析评估了标准化处方、阿片类药物教育和麻醉品处置系统的实施情况。
这项倡议在接受乳房手术的患者中实施了 1 年。该项目包括以下内容：1）实施标准化处方，2）自愿和匿名调查分析，以及 3）关于阿片类药物风险、木炭处置袋分发的术前教育，以及后续调查，以评估使用和干预措施的使用情况。
在干预前，53 名患者完成了调查，其中 60%（n=32）接受了肿块切除术。90%的患者开了麻醉处方；服用的药丸中位数为 3 颗（范围为 0-24 颗），但 93%的患者认为非麻醉剂更有效。83%的患者有未使用的药丸，58%的患者将这些药丸放在未上锁的柜子里。在干预后，66 名患者完成了调查，其中 48%（n=32）接受了肿块切除术。88%的患者开了麻醉处方，服用的药丸中位数为 4 颗（范围为 0-40 颗），89%的患者有剩余的药丸。67%的患者认为教育手册有用，37%（n=17）的患者报告使用了木炭袋。在干预前后的调查中，患者术后疼痛控制满意度评分中位数均为 4.5（5 分李克特量表，1=非常不满意，5=非常满意）。
这项研究包括标准化处方参数、阿片类药物教育和处置方法的实施，被认为是可行的、有益的，并且不会影响术后疼痛控制。
