Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO.
Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO.
Surgery. 2022 Nov;172(5):1407-1414. doi: 10.1016/j.surg.2022.06.033. Epub 2022 Sep 8.
Excess postoperative opioid prescribing increases the risk of opioid abuse, diversion, and addiction. Clinicians receive variable training for opioid prescribing, and despite the availability of guidelines, wide variations in prescribing practices persist. This quality improvement initiative aimed to assess and improve institutional adherence to published guidelines.
This study represented a quality improvement initiative at an academic medical center implemented over a 6-month period with data captured 1 year before and after implementation. The quality improvement initiative focused on prescribing education and monthly feedback reports for clinicians. All opioid-naïve, adult patients undergoing a reviewed procedure were included. Demographics, surgical details, hospital course, and opioid prescriptions were reviewed. Opioids prescribed on discharge were evaluated for concordance with recommendations based on published guidelines. Pre- and postimplementation cohorts were compared.
There were 4,905 patients included: 2,343 preimplementation and 2,562 postimplementation. There were similar distributions in patient demographics between the 2 cohorts. Guideline-concordant discharge prescriptions improved from 50.3% to 72.2% after the quality improvement initiative was implemented (P < .001). Adjusted analysis controlling for sex, age, discharge clinician, length of stay, outpatient surgery, and procedure demonstrated a 190% increase in odds of receiving a guideline-concordant opioid prescription on discharge in the postimplementation cohort (adjusted odds ratio 2.90; 95% confidence interval = 2.55-3.30).
This study represented a successful quality improvement initiative improving guideline-concordant opioid discharges and decreasing overprescribing. This study suggested published guidelines are insufficient without close attention to elements of effective change management including the critical importance of locally targeting educational efforts and suggested that real-time, data-driven feedback amplifies impact on prescribing behavior.
过量开具术后阿片类药物处方会增加阿片类药物滥用、转移和成瘾的风险。临床医生接受的阿片类药物处方培训存在差异，尽管有指南可用，但处方实践仍存在广泛差异。本质量改进计划旨在评估和提高机构对已发布指南的依从性。
本研究是在学术医疗中心实施的质量改进计划，在实施前后各进行了 6 个月的数据采集，为期 1 年。质量改进计划侧重于为临床医生提供处方教育和每月反馈报告。所有接受过审查程序的阿片类药物初治成年患者均纳入研究。回顾患者的人口统计学资料、手术细节、住院过程和阿片类药物处方。评估出院时开具的阿片类药物是否符合基于已发表指南的建议。比较实施前后的队列。
共纳入 4905 例患者：实施前 2343 例，实施后 2562 例。两组患者的人口统计学特征分布相似。质量改进计划实施后，出院时遵循指南的处方比例从 50.3%提高到 72.2%（P <.001）。调整性别、年龄、出院医生、住院时间、门诊手术和手术类型后，实施后队列出院时接受符合指南的阿片类药物处方的可能性增加了 190%（调整后的优势比 2.90；95%置信区间 2.55-3.30）。
本研究代表了一项成功的质量改进计划，提高了符合指南的阿片类药物出院处方比例，减少了过度处方。本研究表明，仅发布指南是不够的，还需要密切关注有效的变革管理要素，包括针对教育努力的本地化的重要性，并表明实时、数据驱动的反馈对处方行为有更大的影响。
