Seo Claire H, Howe Katherine L, McAllister Kelly B, McDaniel Bradford L, Sharp Hunter D, Lucktong Tananchai A, Bower Katie L, Collier Brian R, Gillen Jacob R
School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Surgery, Carilion Roanoke Memorial Hospital, Roanoke, Virginia.
J Surg Res. 2023 Oct;290:52-60. doi: 10.1016/j.jss.2023.03.049. Epub 2023 May 15.
Excessive opioid use after sustaining trauma has contributed to the opioid epidemic. Standardizing the quantity of opioids prescribed at discharge can improve prescribing behavior. We hypothesized that adopting new electronic medical record order sets would be associated with decreased morphine milligram equivalents (MME) prescribed at discharge for trauma patients.
This was a quasi-experimental study examining opioid prescribing practices at a Level 1 Trauma Center. All patients ages 18-89 admitted to the Trauma Service from January 2017 through March 2021 and hospitalized for at least 2 d were included. In November 2020, new trauma admission and discharge order sets were implemented with recommended discharge opioid quantity based on inpatient opioid usage the day prior to discharge multiplied by five. Postintervention prescribing practices were compared to historical controls. The primary outcome was MME at discharge.
Baseline characteristics between preintervention and postintervention cohorts were comparable. There was a significant reduction in median MME prescribed at discharge postintervention (112.5 versus 75.0, P < 0.0001). Median inpatient MME usage also significantly reduced postintervention (184.1 versus 160.5; P < 0.0001). There were trends toward increased ideal prescribing per order set recommendation and a reduction in overprescribing. Patients receiving the recommended opioid quantity at discharge had the lowest opioid refill prescription rate (under: 29.6%, ideal: 7.3%, over: 19.7%, P < 0.0001).
For trauma patients requiring inpatient opioid therapy, a pragmatic and individualized intervention was associated with a reduced quantity of discharge opioids without negative outcomes. Reduction in inpatient opioid use was also associated with standardizing prescribing practices of surgeons with electronic medical record order sets.
创伤后过量使用阿片类药物加剧了阿片类药物流行。规范出院时开具的阿片类药物数量可改善处方行为。我们假设采用新的电子病历医嘱集将与创伤患者出院时开具的吗啡毫克当量（MME）减少相关。
这是一项在一级创伤中心检查阿片类药物处方实践的准实验研究。纳入了2017年1月至2021年3月入住创伤科、年龄在18 - 89岁且住院至少2天的所有患者。2020年11月，实施了新的创伤入院和出院医嘱集，根据出院前一天的住院阿片类药物使用量乘以五来推荐出院阿片类药物数量。将干预后的处方实践与历史对照进行比较。主要结局是出院时的MME。
干预前和干预后队列的基线特征具有可比性。干预后出院时开具的MME中位数显著降低（112.5对75.0，P < 0.0001）。干预后住院期间的MME使用中位数也显著降低（184.1对160.5；P < 0.0001）。每个医嘱集建议的理想处方有增加趋势，过度处方有减少趋势。出院时接受推荐阿片类药物数量的患者阿片类药物再填充处方率最低（不足：29.6%，理想：7.3%，过量：19.7%，P < 0.0001）。
对于需要住院阿片类药物治疗的创伤患者，一种实用且个性化的干预措施与出院时阿片类药物数量减少相关且无不良后果。住院阿片类药物使用的减少也与通过电子病历医嘱集规范外科医生的处方实践相关。
