Plonowska-Hirschfeld Karolina A, Saroya Jasmeet, Herrera Jose, Chang Jolie L, Goldberg Andrew N, Seth Rahul, Durr Megan L
Department of Otolaryngology-Head and Neck Surgery Washington University in St. Louis St. Louis Missouri USA.
Department of Otolaryngology-Head and Neck Surgery University of California San Francisco San Francisco California USA.
OTO Open. 2025 Apr 7;9(2):e70106. doi: 10.1002/oto2.70106. eCollection 2025 Apr-Jun.
This study aims to assess a quality improvement intervention to decrease opiate prescriptions at discharge and improve patient access to multimodal analgesics (MMA) after otolaryngologic surgery.
Longitudinal quality improvement initiative with retrospective prescription trend review and prospective patient questionnaire collection.
An academic medical center.
Opioid, acetaminophen, and non-steroidal anti-inflammatory drug (NSAID) discharge prescriptions after otolaryngologic procedures were reviewed. Two annual department-wide workshops were carried out to review the literature on published MMA protocols and develop standardized post-operative pain medication instructions to reduce opioid use. Concurrently, a patient survey was distributed to evaluate discharge pain medication use and satisfaction with pain control.
Discharge pain medications were reviewed for 9064 procedures between January 2021 and May 2024. After the interventions above, the percentage of patients receiving opioids at discharge decreased from 61.4% to 46.8% ( < .00001). Concurrently, acetaminophen and NSAID discharge prescriptions increased from 24.3% and 10.2% to 67.4% and 46.1%, respectively (both < .00001). Among 100 patients surveyed, satisfaction with post-operative pain control was high before and after the implementation of standardized discharge instructions, even though fewer post-intervention patients received opioids at discharge (49.1% compared to 76.6% pre-intervention, = .007). Notably, 27% of patients prescribed opioids reported not taking them and 23% reported saving unused opioids for future use.
Implementation of standardized post-operative pain medication instructions at discharge after otolaryngologic procedures led to a substantial decrease in opioids prescribed while maintaining patient satisfaction with post-operative pain management. A significant proportion of patients reported saving unused opioids for future use despite standardized safe disposal instructions.
本研究旨在评估一项质量改进干预措施，以减少出院时的阿片类药物处方，并改善耳鼻喉科手术后患者获得多模式镇痛药物（MMA）的机会。
采用纵向质量改进计划，回顾性分析处方趋势，并前瞻性收集患者问卷。
一家学术医疗中心。
对耳鼻喉科手术后出院时开具的阿片类药物、对乙酰氨基酚和非甾体抗炎药（NSAID）处方进行审查。每年举办两次全科室研讨会，回顾已发表的MMA方案相关文献，并制定标准化的术后疼痛药物使用说明，以减少阿片类药物的使用。同时，发放患者调查问卷，评估出院时疼痛药物的使用情况以及对疼痛控制的满意度。
对2021年1月至2024年5月期间的9064例手术的出院疼痛药物处方进行了审查。经过上述干预措施后，出院时接受阿片类药物治疗的患者比例从61.4%降至46.8%（P<0.00001）。同时，对乙酰氨基酚和NSAID出院处方分别从24.3%和10.2%增至67.4%和46.1%（均P<0.00001）。在接受调查的100例患者中，尽管干预后出院时接受阿片类药物治疗的患者较少（干预后为49.1%，干预前为76.6%，P=0.007），但在实施标准化出院说明前后，患者对术后疼痛控制的满意度都很高。值得注意的是，27%开具阿片类药物处方的患者报告未服用，23%报告将未使用的阿片类药物留存以备将来使用。
耳鼻喉科手术后出院时实施标准化的术后疼痛药物使用说明，在保持患者对术后疼痛管理满意度的同时，使开具的阿片类药物大幅减少。尽管有标准化的安全处置说明，但仍有相当比例的患者报告将未使用的阿片类药物留存以备将来使用。
