减少骨科手术后出院时的阿片类药物处方：指南和教育能否在一年后改善处方行为？

Reducing opioid prescribing on discharge after orthopaedic surgery: does a guideline and education improve prescribing practice 1 year later?

作者信息

Stanley Beata, Collins Lisa, Norman Amanda, Bonomo Anthony, Bonomo Yvonne

机构信息

Department of Addiction Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.

Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.

出版信息

ANZ J Surg. 2022 May;92(5):1171-1177. doi: 10.1111/ans.17557. Epub 2022 Feb 21.

DOI:10.1111/ans.17557

PMID:35188322

Abstract

BACKGROUND

An intervention Prescription Opioid Practice Improvement (POPI), addressing opioid prescribing on discharge following orthopaedic surgery, demonstrated improved practice. Here we report the sustainability of improved practice at 12 months, and the impact of a booster education intervention, POPI SOS (Safe Opioid Supply).

METHODS

Audits were performed using methodology described in previously published studies.

RESULTS

High proportion of patients were discharged on opioids, 89.9% 12 months post-POPI (n = 149) and 82.2% post-POPI SOS (n = 169). Twelve months post-POPI there was a significant reduction in combination immediate (IR) and slow release (SR) opioids, 45.7% at the end of POPI program to 34.3% at 12 months (χ (1, N = 364) = 4.47, ρ = 0.034); a significant decrease in opioid-weaning plans, 87.4% at the end of POPI program to 35.8% at 12 months (χ (1, N = 365) = 104.19, ρ = <0.001); and a significant increase in provision of full quantities of SR-opioids, 6.1% after the POPI program to 15.7% (χ (1, N = 364) = 8.95, ρ = 0.003). The POPI SOS booster program significantly improved measures including reduction in combination IR and SR, 34.3-22.3% (χ (1, N = 273) = 4.87, ρ = 0.028) and an increase in opioid plans in discharge summaries, from 35.8% to 77.7% (χ (1, N = 273) = 48.87, ρ < 0.001).

CONCLUSION

Better practice in relation to opioid prescribing is achievable but, for sustained improvement, opioid stewardship activities are needed to reduce the potential harms associated with prescription opioids.

摘要

背景

一项干预措施——骨科手术后出院时阿片类药物处方实践改进（POPI），显示出实践得到了改善。在此，我们报告12个月时改进实践的可持续性，以及强化教育干预措施——POPI SOS（安全阿片类药物供应）的影响。

方法

采用先前发表的研究中描述的方法进行审计。

结果

高比例患者出院时使用阿片类药物，POPI实施后12个月为89.9%（n = 149），POPI SOS实施后为82.2%（n = 169）。POPI实施12个月后，即释（IR）和缓释（SR）阿片类药物联合使用量显著减少，从POPI项目结束时的45.7%降至12个月时的34.3%（χ(1, N = 364) = 4.47，ρ = 0.034）；阿片类药物减量计划显著减少，从POPI项目结束时的87.4%降至12个月时的35.8%（χ(1, N = 365) = 104.19，ρ < 0.001）；足量提供SR-阿片类药物的比例显著增加，从POPI项目后的6.1%增至15.7%（χ(1, N = 364) = 8.95，ρ = 0.003）。POPI SOS强化项目显著改善了多项指标，包括IR和SR联合使用量的减少，从34.3%降至22.3%（χ(1, N = 273) = 4.87，ρ = 0.028），以及出院小结中阿片类药物计划的增加，从35.8%增至77.7%（χ(1, N = 273) = 48.87，ρ < 0.001）。