Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Australia.
Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
Anaesth Intensive Care. 2023 Jul;51(4):239-253. doi: 10.1177/0310057X231160800. Epub 2023 Jun 20.
SummaryOpioids are often used to provide postsurgical analgesia but may cause harm if used inappropriately. We introduced an opioid stewardship program in three Melbourne hospitals to reduce the inappropriate use of opioids after patient discharge. The program had four pillars: prescriber education, patient education, a standardised quantity of discharge opioids, and general practitioner (GP) communication. Following introduction of the program, we undertook this prospective cohort study. The study aimed to describe post-program discharge opioid prescribing, patient opioid use and handling, and the impact of patient demographics, pain and surgical treatment factors on discharge prescribing. We also evaluated compliance with the program components. We recruited 884 surgical patients from the three hospitals during the ten-week study period. Discharge opioids were dispensed to 604 (74%) patients, with 20% receiving slow-release opioids. Junior medical staff undertook 95% of discharge opioid prescribing, which was guideline-compliant for 78% of patients. Of the patients discharged with opioids, a GP letter was sent for only 17%. Follow-up at two weeks was successful in 423 (70%) patients and in 404 (67%) at three months. At the three-month follow-up, 9.7% of patients reported ongoing opioid use; in preoperatively opioid naïve patients, the incidence was 5.5%. At the two-week follow-up, only 5% reported disposal of excess opioids, increasing to 26% at three months. Ongoing opioid therapy at three months in our study cohort (9.7%; 39/404) was associated with preoperative opioid consumption and higher pain scores at the three-month follow-up. The introduction of the opioid stewardship program resulted in highly guideline-compliant prescribing, but hospital-to-GP communication was uncommon and opioid disposal rates were low. Our findings suggest that opioid stewardship programs can improve postoperative opioid prescribing, use and handling, but the realisation of these gains will require effective program implementation.
阿片类药物常用于提供术后镇痛，但如果使用不当可能会造成伤害。我们在墨尔本的三家医院引入了阿片类药物管理计划，以减少患者出院后阿片类药物的不当使用。该计划有四个支柱：医生教育、患者教育、标准化的出院阿片类药物剂量和全科医生（GP）沟通。在引入该计划后，我们进行了这项前瞻性队列研究。该研究旨在描述计划实施后的出院阿片类药物处方、患者阿片类药物使用和处理情况，以及患者人口统计学、疼痛和手术治疗因素对出院处方的影响。我们还评估了计划实施情况。在为期十周的研究期间，我们从这三家医院招募了 884 名手术患者。604 名（74%）患者出院时开具了阿片类药物，其中 20%患者服用了缓释阿片类药物。初级医务人员开具了 95%的出院阿片类药物处方，其中 78%的患者处方符合指南。开具了阿片类药物的患者中，只有 17%的患者收到了 GP 信函。在 423 名（70%）患者中成功进行了两周随访，在 404 名（67%）患者中进行了三个月随访。在三个月随访时，9.7%的患者报告仍在使用阿片类药物；在术前未使用过阿片类药物的患者中，这一比例为 5.5%。在两周随访时，只有 5%的患者报告处理了多余的阿片类药物，在三个月随访时这一比例增加到 26%。在我们的研究队列中，三个月时持续使用阿片类药物（9.7%；39/404）与术前阿片类药物的使用情况和三个月时更高的疼痛评分相关。阿片类药物管理计划的引入导致了高度符合指南的处方，但医院与 GP 的沟通并不常见，阿片类药物的处理率也很低。我们的研究结果表明，阿片类药物管理计划可以改善术后阿片类药物的使用和处理情况，但要实现这些改善，需要有效的计划实施。
