Category: Professional Posters
Purpose: Opioid prescription is a common phenomenon for surgical patients on hospital discharge. Rates of unused opioids after surgical procedures range from 34% to 71%. The consequences of these unused opioids is unknown and may result in their misuse and abuse, which is a concern amidst the current opioid crisis. Our study aims to reduce the average oral morphine equivalents (OME) dispensed by community pharmacies between hospital discharge and 4-6 weeks post-total hip arthroplasty (THA) and total knee arthroplasty (TKA).
Methods: A quality improvement (QI) study was conducted at a university-affiliated hospital using a before and after study design. A multidisciplinary team including an orthopedic surgeon and resident, pharmacists, an anesthesiologist, an acute pain service nurse practitioner, a nurse-in-charge, a nurse educator, and physiotherapists, evaluated the overprescribing problem and developed the QI intervention. The intervention included part-fill opioid prescriptions along with a pain management pamphlet for patients, which started on December 11, 2018. The amount of OME dispensed from hospital discharge to 4-6 weeks after THA or TKA, when patients stopped using opioids after surgery, the number of opioids left in the first opioid pill bottle, request for additional opioid prescriptions and overall patient satisfaction with opioid management were assessed pre- and post-intervention. These measures were collected from the initial prescription provided at discharge and patient surveys at the first follow-up clinic visit 4-6 weeks after TKA or THA surgery. Data from November 1st to December 10th, 2018 was compared to data from December 11th, 2018 to February 15th, 2019.
Results: From November 1st, 2018 to February 15th, 2019, 276 patients had THA or TKA. The mean survey response rate was 61% (58% before vs. 62% after intervention). Characteristics pre- and post-intervention including mean age (65 years vs. 64 years), gender (42% vs. 45% male ) and type of surgery (60% vs. 58% THA) were similar. After the intervention, the mean OME dispensed from discharge to 4-6 weeks after surgery reduced from 530 to 400mg OME (p= < 0.00001) and no change in duration of opioid use (p=0.3749), number of opioids left (p= 0.704), additional opioid prescription requests (p=0.4335), and overall patient satisfaction with opioid management (p= 0.1086).
Conclusion: The part-filled opioid prescriptions and patient education pamphlets intervention reduced the mean total opioids dispensed from 530 to 400mg OME, which indicates a 25% reduction in number of opioids dispensed from the community pharmacy. Patient satisfaction with overall opioid prescription treatment was not affected suggesting that part-fill opioid prescriptions were not too inconvenient. Since the duration of opioid use, the number of leftover opioids and request for additional opioids did not change, patients were using opioids more sparingly when opioids were prescribed in a part-fill format.