Effectiveness of a discharge analgesia guideline on discharge opioid prescribing after a surgical procedure from a tertiary metropolitan hospital
DOI:
https://doi.org/10.5055/jom.0863Keywords:
opioid analgesics, discharge, guidelines, analgesic discharge planAbstract
Objective: The primary objective of this study was to evaluate the effectiveness of a discharge analgesia guideline on the number of days' supply of opioid analgesics provided among surgical patients upon hospital discharge. The secondary objective was to analyze the effect of this guideline on the provision of an analgesic discharge plan.
Design: A retrospective historical control cohort study.
Setting: A tertiary metropolitan hospital.
Interventions: A discharge analgesia guideline recommending the supply of opioid analgesics on discharge based on patient use in the 24 hours prior to discharge and the supply of an analgesic discharge plan.
Main outcome measure(s): The primary outcome measure was the number of days' supply of opioids. The secondary outcome measure was the proportion of patients receiving an analgesic discharge plan.
Results: There was no change in the number of days' supply of opioids provided on discharge (median, interquartile range: 5, 3-9.75 vs 6, 4-10; p = 0.107) and in the proportion of patients receiving an analgesic discharge plan (26 percent vs 22.2 percent; p = 0.604). The results of two multivariable regression models showed no change in the number of days' supply of opioids (adjusted incidence rate ratio, 95 percent confidence interval [CI]: 1.1, 0.9-1.2) and the provision of an analgesic discharge plan (adjusted odds ratio, 95 percent CI: 0.6, 0.2-1.4) after adjusting for confounding variables.
Conclusion: Overall, our study found no change in the number of days' supply of opioids provided on discharge and the provision of an analgesic discharge plan after implementation of a discharge analgesia guideline, but we also found that prescribing practices already aligned with the guideline before its implementation.
References
Bicket MC, Long JJ, Pronovost PJ, et al.: Prescription opioid analgesics commonly unused after surgery: A systematic review. JAMA Surg. 2017; 152(11): 1066-1071. DOI: https://doi.org/10.1001/jamasurg.2017.0831
Allen ML, Kim CC, Braat S, et al.: Post-discharge opioid use and handling in surgical patients: A multicentre prospective cohort study. Anaesth Intensive Care. 2020; 48(1): 36-42. DOI: https://doi.org/10.1177/0310057X19895019
Levy N, Quinlan J, El-Boghdadly K, et al.: An international multidisciplinary consensus statement on the prevention of opioid-related harm in adult surgical patients. Anaesthesia. 2021; 76(4): 520-536. DOI: https://doi.org/10.1111/anae.15262
Stark N, Kerr S, Stevens J: Prevalence and predictors of persistent post-surgical opioid use: A prospective observational cohort study. Anaesth Intensive Care. 2017; 45(6): 700-706. DOI: https://doi.org/10.1177/0310057X1704500609
Baldini A, von Korff M, Lin EH: A review of potential adverse effects of long-term opioid therapy: A practitioner's guide. Prim Care Companion CNS Disord. 2012; 14(3): PCC.11m01326. DOI: https://doi.org/10.4088/PCC.11m01326
Wetzel M, Hockenberry J, Raval M: Interventions for postsurgical opioid prescribing: A systematic review. JAMA Surg. 2018; 153(10): 948-954. DOI: https://doi.org/10.1001/jamasurg.2018.2730
Feinberg AE, Chesney TR, Srikandarajah S, et al.: Opioid use after discharge in postoperative patients: A systematic review. Ann Surg. 2018; 267(6): 1056-1062. DOI: https://doi.org/10.1097/SLA.0000000000002591
Phinn K, Liu S, Patanwala AE, et al.: Effectiveness of organisational interventions on appropriate opioid prescribing for noncancer pain upon hospital discharge: A systematic review. Br J Clin Pharmacol. 2023; 89(3): 982-1002. DOI: https://doi.org/10.1111/bcp.15633
Stewart JE, Tuffin PH, Kay J, et al.: The effect of guideline implementation on discharge analgesia prescribing (two years on). Anaesth Intensive Care. 2019; 47(1): 40-44. DOI: https://doi.org/10.1177/0310057X18811746
Peterman DE, Knoedler BP, Ewing JA, et al.: Implementation of an evidence-based protocol significantly reduces opioid prescribing after ventral hernia repair. Am Surg. 2020; 86(11): 1602-1606. DOI: https://doi.org/10.1177/0003134820942207
Donaldson SR, Harding AM, Taylor SE, et al.: Evaluation of a targeted prescriber education intervention on emergency department discharge oxycodone prescribing. Emerg Med Australas. 2017; 29(4): 400-406. DOI: https://doi.org/10.1111/1742-6723.12772
Stanley B, Jackson A, Norman A, et al.: Opioid prescribing improvement in orthopaedic specialty unit in a tertiary hospital: A retrospective audit of hospital discharge data pre- and post-intervention for better opioid prescribing practice. ANZ J Surg. 2019; 89(10): 1302-1307. DOI: https://doi.org/10.1111/ans.15305
Ganti A, Eggerstedt M, Grudzinski K, et al.: Enhanced recovery protocol for transoral robotic surgery demonstrates improved analgesia and narcotic use reduction. Am J Otolaryngol. 2020; 41(6): 102649. DOI: https://doi.org/10.1016/j.amjoto.2020.102649
Linder BJ, Occhino JA, Wiest SR, et al.: Assessing the impact of procedure-specific opioid prescribing recommendations on opioid stewardship following pelvic organ prolapse surgery. Am J Obstet Gynecol. 2019; 221(5): 515.e1-515-e8. DOI: https://doi.org/10.1016/j.ajog.2019.06.023
Sada A, Glasgow AE, Dy BM, et al.: Impact of opioid prescribing guidelines on prescribing at discharge from endocrine surgery. Am J Surg. 2021; 221(2): 455-459. DOI: https://doi.org/10.1016/j.amjsurg.2020.08.004
Pace C, Shah S, Zhang AX, et al.: Impact of a chronic pain management pathway on opioid administration and prescribing in an emergency department. Clin Toxicol. 2018; 56(8): 744-750. DOI: https://doi.org/10.1080/15563650.2017.1401081
Erdfelder E, FAul F, Buchner A, et al.: Statistical power analyses using G*power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009; 41(4): 1149-1160. DOI: https://doi.org/10.3758/BRM.41.4.1149
Australian Consortium for Classification Development: The Australian Classification of Health Interventions (ACHI) –Eleventh Edition – Tabular List of Interventions and Alphabetic Index of Interventions. Adelaide: IHPA, 2018.
Australian Consortium for Classification Development: The International Statistical Classification of Diseases and Related Health Problems – Tenth Revision, Australian Modification (ICD-10-AM/ACHI/ACS). Sydney: IHPA, 2019.
Sundararajan V, Henderson T, Perry C, et al.: New ICD-10 version of the Charlson Comorbidity Index predicted in-hospital mortality. J Clin Epidemiol. 2004; 57(12): 1288-1294. DOI: https://doi.org/10.1016/j.jclinepi.2004.03.012
Nielsen S, Degenhardt L, Hoban B, et al.: Comparing opioids: A guide to estimating oral morphine equivalents (OME) in research. Technical Report No. 329, National Drug and Alcohol Research Centre, University of NSW, Sydney, 2014.
NSW Health: Medication handling in NSW public health facilities. 2013. Available at https://www.health.nsw.gov.au/pharmaceutical/Pages/medication-handling-pubhealth.aspx. Accessed April 12, 2021.
Bedard NA, Pugely AJ, Westermann RW, et al.: Opioid use after total knee arthroplasty: Trends and risk factors for prolonged use. J Arthroplasty. 2017; 32(8): 2390-2394. DOI: https://doi.org/10.1016/j.arth.2017.03.014
Rao AG, Chan PH, Prentice HA, et al.: Risk factors for postoperative opioid use after elective shoulder arthroplasty. J Shoulder Elbow Surg. 2018; 27(11): 1960-1968. DOI: https://doi.org/10.1016/j.jse.2018.04.018
Australian and New Zealand College of Anaesthetists: Position statement on the use of slow release opioids. 2019. Available at https://www.anzca.edu.au/getattachment/d9e2a7c5-0f17-42d3-bda7-c6dae7e55ced/Position-statementon-the-use-of-slow-release-opioid-preparations-in-thetreatment-of-acute-pain. Accessed April 12, 2021.
Michigan Opioid Prescribing Engagement Network: Opioid prescribing recommendations. 2021. Available at https://michigan-open.org/prescribing-recommendations/. Accessed April 12, 2021.
Damschroder LJ, Aron DC, Keith RE, et al.: Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implement Sci. 2009; 4(50). DOI: 10.1186/1748-5908-4-50. DOI: https://doi.org/10.1186/1748-5908-4-50
Miech EJ, Rattray NA, Flanagan ME, et al.: Inside help: An integrative review of champions in healthcare-related implementation. SAGE Open Med. 2018; 6: 1-11. DOI: https://doi.org/10.1177/2050312118773261
Downloads
Published
How to Cite
Issue
Section
License
Copyright 2005-2024, Weston Medical Publishing, LLC
All Rights Reserved
