12228 Department of Surgery, Yale School of Medicinex, New Haven, CT, USA.
Am Surg. 2021 May;87(5):771-776. doi: 10.1177/0003134820940627. Epub 2020 Nov 11.
In academic hospitals, surgical residents write most of the postoperative prescriptions; yet, few residents are trained on postoperative analgesia. This leads to wide variability in practices and often excess opioid prescribing. We sought to create an opioid guideline pocket card for surgical residents to access when prescribing opioids postoperatively and to evaluate the impact of this initiative.
A comprehensive literature review was conducted to generate evidence-based procedure-specific opioid recommendations; additional recommendations were formulated via consensus opinion from surgical divisions at an academic institution. A pocket-sized guideline card was developed to include these procedure-specific recommendations as well as opioid guidelines for discharges after inpatient stays, non-opioid analgesic recommendations, access to opioid safety and disposal instructions for patients discharge, an equianalgesic dosing chart, and instructions for naloxone use. The card was distributed to all General Surgery house staff at a university-affiliated hospital in the spring of 2018. Following the distribution, trainees were surveyed on their use of the card. Descriptive statistics were used to analyze the survey.
Of 85 trainees, 62 (72.9%) responded to the survey in full; 58% use the card regularly. Of the 27 junior resident respondents, 70.4% use the card at least monthly including 48.1% who use the card daily-to-weekly. Overall, 81.6% of residents changed their opioid-prescribing practices because of this initiative and 89.8% believe the card should continue to be distributed and used.
An evidence-based guideline card for postoperative analgesia is highly valued and utilized by surgical trainees, especially those most junior in their training.
在学术医院中，外科住院医师撰写大多数术后处方；然而，很少有住院医师接受过术后镇痛培训。这导致实践中的差异很大，往往过量开具阿片类药物。我们旨在为外科住院医师创建一张阿片类药物指南袖珍卡，以便在术后开具阿片类药物时使用，并评估该举措的影响。
进行了全面的文献回顾，以生成基于证据的特定手术阿片类药物推荐；通过学术机构的外科科室的共识意见制定了其他推荐。制作了袖珍指南卡，包括特定手术的推荐以及住院后出院的阿片类药物指南、非阿片类镇痛药物推荐、患者出院时获得阿片类药物安全和处置说明的途径、等效剂量图表以及纳洛酮使用说明。该卡于 2018 年春季分发给附属大学医院的所有普通外科住院医师。分发后，对受训者使用该卡的情况进行了调查。使用描述性统计对调查进行分析。
在 85 名受训者中，有 62 名（72.9%）完整回答了调查问题；58%的人经常使用该卡。在 27 名初级住院医师受访者中，70.4%的人至少每月使用该卡，其中 48.1%的人每天到每周使用该卡。总体而言，81.6%的住院医师因该举措改变了其阿片类药物处方行为，89.8%的人认为应继续分发和使用该卡。
术后镇痛的基于证据的指南卡在外科住院医师中非常有价值且得到广泛应用，尤其是在培训初期的住院医师中。
