Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Am J Otolaryngol. 2021 Jul-Aug;42(4):102991. doi: 10.1016/j.amjoto.2021.102991. Epub 2021 Feb 18.
In opioid-naive patients, many low-risk surgical procedures are associated with an increased risk of chronic opioid use. The goal of this quality improvement project was to reduce the amount of opioid prescriptions after commonly performed surgeries in otolaryngology.
Pre-intervention opioid prescribing state was measured using anonymous provider and patient surveys, as well as pharmacy provider prescription data. Next, this information was used to develop an opioid prescription protocol that both standardized opioid prescribing practices and encouraged multimodal analgesia following routine surgery. Finally, post-intervention data were gathered and compared to pre-intervention data to assess changes in prescribing patterns.
By patient survey, the worst pain and average pain after surgery (scale of 1-10) were unchanged after the intervention (5.1 to 4.8, p = 0.52; 4.1 to 3.6, p = 0.35, respectively). Post-intervention, 41% of patients reported receiving no opiates, whereas pre-intervention 100% of patients surveyed received opiates. The amount of ibuprofen and acetaminophen prescribed post-intervention increased 113% and 71%, respectively. By survey, the average number of opioid doses decreased from 24.0 ± 7.0 to 18.4 ± 6.6 (p = 0.018).
The implementation of a standardized physician opioid prescription protocol did not affect patient pain perceptions, resulted in an increase in multimodal analgesia prescription, and increased provider awareness of opioid over prescription.
在阿片类药物初治患者中，许多低风险的手术与慢性阿片类药物使用风险增加相关。本质量改进项目的目标是减少耳鼻喉科常见手术术后阿片类药物的处方量。
采用匿名医生和患者调查以及药房提供者处方数据来测量干预前的阿片类药物处方情况。接下来，利用这些信息制定阿片类药物处方方案，标准化阿片类药物的使用，并鼓励在常规手术后进行多模式镇痛。最后，收集干预后的数据并与干预前的数据进行比较，以评估处方模式的变化。
通过患者调查，术后最痛和平均疼痛（1-10 分制）在干预后没有变化（分别为 5.1 分降至 4.8 分，p=0.52；4.1 分降至 3.6 分，p=0.35）。干预后，41%的患者报告未服用阿片类药物，而干预前接受调查的 100%的患者均服用阿片类药物。干预后开具的布洛芬和对乙酰氨基酚的处方量分别增加了 113%和 71%。通过调查，阿片类药物的平均剂量从 24.0±7.0 降至 18.4±6.6（p=0.018）。
实施标准化医生阿片类药物处方方案并未影响患者的疼痛感知，增加了多模式镇痛的处方，提高了提供者对阿片类药物过度处方的认识。
