Rennert Lior, Howard Kerry A, Walker Kevin B, Furmanek Douglas L, Blackhurst Dawn W, Cancellaro Vito A, Litwin Alain H
From the Department of Public Health Sciences, Clemson University, Clemson.
Prisma Health-Upstate, Greenville.
J Patient Saf. 2023 Mar 1;19(2):71-78. doi: 10.1097/PTS.0000000000001088. Epub 2022 Dec 19.
Overprescribing to opioid-naive surgical patients substantially contributes to opioid use disorders, which have become increasingly prevalent. Opioid stewardship programs (OSPs) within healthcare settings provide an avenue for introducing interventions to regulate prescribing. This study examined the association of OSP policies limiting exposure on changes in surgery-related opioid prescriptions and patient pain.
We evaluated policies implemented by an OSP in a large American healthcare system between 2016 and 2018: nonopioid medication during surgery, decrease of available opioid dosage vials in operating rooms, standardization of opioid in-patient practices through electronic health record alerts, and limit to postsurgery opioid supply. Generalized linear mixed effects models examined the association of interventions with outcome changes in 9262 opioid-naive patients undergoing elective surgery. Outcomes were discharge pain, morphine milligram equivalent in the first prescription postsurgery, and opioid prescription refills.
Decreases in all prescription outcomes and discharge pain were observed following onset of OSP interventions ( P 's < 0.001). Among individual policies, standardization of in-patient prescribing practices was associated with the strongest decrease in prescribed morphine milligram equivalent. Importantly, there was no evidence of an increase in discharge pain related to any intervention.
This study promotes the potential of OSP formation and policies to reduce opioid prescribing without compromising patient pain. The most effective policy, standardization of in-patient prescribing practices through alerts, suggests that reminding prescribers to re-evaluate the patient's need is effective in changing behavior. The findings offer considerations for OSP formation and policy implementation across health systems to improve quality and safety in opioid prescribing.
对未使用过阿片类药物的外科手术患者过度开具阿片类药物处方，在很大程度上导致了阿片类药物使用障碍，而此类障碍已日益普遍。医疗机构内的阿片类药物管理计划（OSP）为引入规范处方的干预措施提供了途径。本研究探讨了限制暴露的OSP政策与手术相关阿片类药物处方变化及患者疼痛之间的关联。
我们评估了2016年至2018年期间美国一个大型医疗系统中OSP实施的政策：手术期间使用非阿片类药物、减少手术室中可用阿片类药物剂量瓶、通过电子健康记录警报实现阿片类药物住院治疗实践的标准化以及限制术后阿片类药物供应。广义线性混合效应模型研究了这些干预措施与9262例接受择期手术的未使用过阿片类药物患者的结局变化之间的关联。结局指标包括出院时的疼痛、术后第一张处方中的吗啡毫克当量以及阿片类药物处方的再填充情况。
OSP干预措施实施后，所有处方结局指标及出院时的疼痛均有所下降（P值<0.001）。在各项单独政策中，住院处方实践的标准化与处方吗啡毫克当量的最大降幅相关。重要的是，没有证据表明任何干预措施会导致出院时疼痛增加。
本研究表明了OSP的形成及政策在不影响患者疼痛的情况下减少阿片类药物处方的潜力。最有效的政策是通过警报实现住院处方实践的标准化，这表明提醒开处方者重新评估患者的需求对改变行为是有效的。这些发现为卫生系统中OSP的形成和政策实施提供了参考，以提高阿片类药物处方的质量和安全性。
