Fields Brittany C, Newhook Timothy E, Lillemoe Heather A, Maxwell Jessica E, Soliz Jose M, Popat Keyuri U, Roland Christina L, Vauthey Jean-Nicolas, Katz Matthew H G, Tzeng Ching-Wei D
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center.
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center.
Adv Cancer Educ Qual Improv. 2025 Jun;1(1). doi: 10.52519/aceqi.25.1.1.a15.
We previously reported that implementation of a department-wide opioid education program led to post-education improvements in opioid perceptions and prescription recommendations, with one-month and one-year retention. With ongoing programmatic and quality improvement efforts, we sought to re-evaluate the retention of these improvements five years after initial efforts.
Attending surgeons, clinical fellows, and advanced practice providers were surveyed five years after implementation of a comprehensive, departmental opioid reduction framework in August 2018. This framework initially consisted of dedicated opioid education sessions and retrospective assessment of prescribing practices, and subsequently expanded over time to include prospective quality improvement and implementation studies, as well as integration of opioid stewardship measures into usual clinical care. Providers' perceptions of expected pain scores, opioid requirements, and ideal prescribing habits were assessed with the same survey administered at 1-month (2018) and 1-year post-initial education (2019).
Eighty-seven of 162 (53.7%) providers responded to the follow-up survey. More providers expressed strong agreement with the statement, "After an inpatient procedure, a patient who has not required opioids for 24 hours before discharge should not receive a discharge opioid prescription." Significant decreases in the number of opioid pills providers would prescribe at discharge for five sample operations were also observed between 2018-2023. Stepwise decreases in opioid volume prescribed in both inpatient and outpatient settings were reported since the initial 2018 education sessions.
Dedicated department-wide opioid education, ongoing quality improvement and prospective evaluation, and integration of opioid stewardship into clinical practice were associated with sustained improvement over five years in perceptions of postoperative pain management and decreased discharge opioid prescription recommendations.
我们之前报告称，实施全科室阿片类药物教育项目可使阿片类药物认知和处方建议在教育后得到改善，并能维持一个月和一年。随着持续的项目规划和质量改进工作，我们试图在最初努力五年后重新评估这些改善情况的持续性。
在2018年8月实施全面的科室阿片类药物减少框架五年后，对主治外科医生、临床住院医师和高级执业提供者进行了调查。该框架最初包括专门的阿片类药物教育课程和对处方实践的回顾性评估，随后随着时间推移扩展到包括前瞻性质量改进和实施研究，以及将阿片类药物管理措施纳入日常临床护理。通过在初始教育后1个月（2018年）和1年（2019年）进行的相同调查，评估提供者对预期疼痛评分、阿片类药物需求和理想处方习惯的看法。
162名提供者中有87名（53.7%）回复了随访调查。更多提供者强烈同意以下陈述：“在住院手术后，出院前24小时未使用阿片类药物的患者不应获得出院阿片类药物处方。”在2018 - 2023年间，还观察到提供者在五种样本手术出院时开具的阿片类药物片数显著减少。自2018年最初的教育课程以来，住院和门诊环境中开具的阿片类药物量均呈逐步下降趋势。
全科室专门的阿片类药物教育、持续的质量改进和前瞻性评估，以及将阿片类药物管理纳入临床实践，与术后疼痛管理认知的持续改善以及出院阿片类药物处方建议的减少相关，持续了五年。
