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A departmental policy can reduce opioid prescribing after orthopedic surgery

Simon C. Mears, MD, PhD, Asa Shnaekel, MD, MPH, John Wilkinson, MD, Caroline Chen, BS, C. Lowry Barnes, MD


Objective: The authors hypothesized that implementation of a department-wide opioid prescribing program would reduce opioid tablets and morphine milligram equivalents (MMEs) prescribed as well as prescription refills.

Design: A retrospective study was conducted to determine the effects of a department wide opioid prescribing policy.

Setting: A university teaching hospital Orthopaedic Surgery Department.

Patients, participants: All prescriptions written by members of our department were reviewed for 3 months before and 3 months after program implementation. There were 1,445 patients in the pre-intervention and 1,209 patients in the postintervention cohort. Two thousand two hundred forty-six total prescriptions written during the pre-intervention period and 1,530 written during the post-intervention period of the study.

Interventions: A departmental opioid prescribing policy was introduced through several department teaching sessions. The policy included recommendations on numbers of tablets per procedures and patient education about the dangers of narcotic medications.

Main outcome measure(s): The primary study outcome measures were the number of opioid tablets prescribed, the number of MMEs prescribed, and the number of prescription refills.

Results: The mean number of tablets per prescription decreased from 47.2 (95% confidence interval (CI): 46.4-47.9) tablets in the pre-intervention cohort to 39.2 (95% CI: 38.1-40.4) tablets in the post-intervention cohort (p < 0.0001). Likewise, the mean MME per prescription decreased from 354 (95% CI: 344-364) in the pre-intervention cohort to 265 (95% CI: 249-281) in the post-intervention cohort (p < 0.0001). A refill prescription was provided 949 times in the pre-intervention group and 404 times in the post-intervention group. Prior to the introduction of prescription guidelines, the average number of prescriptions was 1.76 per patient (95% CI: 1.71-1.81). This fell to 1.34 prescriptions per patient (95% CI: 1.31-1.38) after policy institution. Noncompliance with policy was not related to provider, service, or procedure size.

Conclusions: Implementation of a departmental policy can successfully reduce the number of opioid tablets and MMEs prescribed per procedure. Policies also decrease the number of refill prescriptions per procedure. Standardization of prescription practices is effective in improving opioid prescription stewardship.

Level of evidence: Level III, retrospective cohort study.


opioid, narcotic, prescription, department policy, pain, surgery

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