Sage Journals: Discover world-class research

Abstract

Background

In academic hospitals, surgical residents write most of the postoperative prescriptions; yet, few residents are trained on postoperative analgesia. This leads to wide variability in practices and often excess opioid prescribing. We sought to create an opioid guideline pocket card for surgical residents to access when prescribing opioids postoperatively and to evaluate the impact of this initiative.

Methods

A comprehensive literature review was conducted to generate evidence-based procedure-specific opioid recommendations; additional recommendations were formulated via consensus opinion from surgical divisions at an academic institution. A pocket-sized guideline card was developed to include these procedure-specific recommendations as well as opioid guidelines for discharges after inpatient stays, non-opioid analgesic recommendations, access to opioid safety and disposal instructions for patients discharge, an equianalgesic dosing chart, and instructions for naloxone use. The card was distributed to all General Surgery house staff at a university-affiliated hospital in the spring of 2018. Following the distribution, trainees were surveyed on their use of the card. Descriptive statistics were used to analyze the survey.

Results

Of 85 trainees, 62 (72.9%) responded to the survey in full; 58% use the card regularly. Of the 27 junior resident respondents, 70.4% use the card at least monthly including 48.1% who use the card daily-to-weekly. Overall, 81.6% of residents changed their opioid-prescribing practices because of this initiative and 89.8% believe the card should continue to be distributed and used.

Discussion

An evidence-based guideline card for postoperative analgesia is highly valued and utilized by surgical trainees, especially those most junior in their training.

Keywords

general surgery resident education

Get full access to this article

View all access options for this article.

References

Guy

GP.

Zhang

Bohm

et al. Vital signs: changes in opioid prescribing in the United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66(26):697-704.doi:10.15585/mmwr.mm6626a4

http://www.ncbi.nlm.nih.gov/pubmed/28683056

Jones

CM.

Paulozzi

LJ.

Mack

. Sources of prescription opioid pain relievers by frequency of past-year nonmedical use: United States, 2008-2011. National center for injury prevention and control, centers for disease control and prevention. JAMA Int Med. 2014;174(5):802-803.

McCabe

SE.

West

BT.

Boyd

. Leftover prescription opioids and nonmedical use among high school seniors: a multi-cohort national study. J Adolesc Health. 2013;52(4):480-485.doi:10.1016/j.jadohealth.2012.08.007

http://www.ncbi.nlm.nih.gov/pubmed/23298996

Hill

MV.

McMahon

ML.

Stucke

RS.

Barth

. Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg. 2017;265(4):709-714.doi:10.1097/SLA.0000000000001993

http://www.ncbi.nlm.nih.gov/pubmed/27631771

Tan

WH.

Feaman

et al. Opioid medication use in the surgical patient: an assessment of prescribing patterns and use. J Am Coll Surg. 2018;227(2):203-211.doi:10.1016/j.jamcollsurg.2018.04.032

http://www.ncbi.nlm.nih.gov/pubmed/29746919

Bicket

MC.

Long

JJ.

Pronovost

PJ.

Alexander

GC.

. Prescription opioid analgesics commonly unused after surgery: a systematic review. JAMA Surg. 2017;152(11):1066-1071.doi:10.1001/jamasurg.2017.0831

http://www.ncbi.nlm.nih.gov/pubmed/28768328

Wunsch

Wijeysundera

DN.

Passarella

MA.

Neuman

. Opioids prescribed after low-risk surgical procedures in the United States, 2004-2012. JAMA. 2016;315(15):1654-1657.doi:10.1001/jama.2016.0130

http://www.ncbi.nlm.nih.gov/pubmed/26978756

Hasak

JM.

Roth Bettlach

CL.

Santosa

KB.

Larson

EL.

Stroud

Mackinnon

. Empowering post-surgical patients to improve opioid disposal: a before and after quality improvement study. J Am Coll Surg. 2018;226(3):235-240.doi:10.1016/j.jamcollsurg.2017.11.023

http://www.ncbi.nlm.nih.gov/pubmed/29331347

Brummett

Division of Pain Medicine DoA University of Michigan Medical School Ann Arbor Institute for Healthcare Policy and Innovation UoM, Ann Arbor, et al . New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2018;152(6)doi:10.1001/jamasurg.2017.0504

10.

Sun

EC.

Darnall

BD.

Baker

LC.

Mackey

. Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Int Med. 2016;176(9):1286-1293.doi:10.1001/jamainternmed.2016.3298

http://www.ncbi.nlm.nih.gov/pubmed/27400458

11.

Lev

Lee

Petro

et al. Who is prescribing controlled medications to patients who die of prescription drug abuse? Am J Emerg Med. 2016;34(1):30-35.doi:10.1016/j.ajem.2015.09.003

http://www.ncbi.nlm.nih.gov/pubmed/26476578

12.

Chiu

AS.

Healy

JM.

DeWane

MP.

Longo

WE.

Yoo

. Trainees as agents of change in the opioid epidemic: optimizing the opioid prescription practices of surgical residents. J Surg Educ. 2018;75(1):65-71.doi:10.1016/j.jsurg.2017.06.020

http://www.ncbi.nlm.nih.gov/pubmed/28705485

13.

Chiu

AS.

Ahle

SL.

Freedman-Weiss

MR.

Yoo

PS.

Pei

. The impact of a curriculum on postoperative opioid prescribing for novice surgical trainees. Am J Surg. 2019;217(2):228-232.doi:10.1016/j.amjsurg.2018.08.007

http://www.ncbi.nlm.nih.gov/pubmed/30180937

14.

Freedman-Weiss

MR.

Chiu

AS.

Solomon

et al. Opioid prescribing habits of general versus pediatric surgeons after uncomplicated laparoscopic appendectomy. J Surg Res. 2019;235:404-409.doi:10.1016/j.jss.2018.09.085

http://www.ncbi.nlm.nih.gov/pubmed/30691822

15.

Howard

Waljee

Brummett

Englesbe

Lee

. Reduction in opioid prescribing through evidence-based prescribing guidelines. JAMA Surg. 2018;153(3):285-287.doi:10.1001/jamasurg.2017.4436

http://www.ncbi.nlm.nih.gov/pubmed/29214318

16.

Opioid Prescribing Recommendations for Surgery . Michigan surgical quality collaborative. Accessed March 2020. https://opioidprescribing.info/

17.

Hill

MV.

Stucke

RS.

Billmeier

SE.

Kelly

JL.

Barth

. Guideline for discharge opioid prescriptions after inpatient general surgical procedures. J Am Coll Surg. 2018;226(6):996-1003.doi:10.1016/j.jamcollsurg.2017.10.012

http://www.ncbi.nlm.nih.gov/pubmed/29198638

18.

Raftopoulos

. Laparoscopic Roux-en-Y gastric bypass without opioids-isOpioids-Is it possible? Eeffect of restricted opioid usage on an established 1-dDay fast-track protocol for laparoscopic Roux-en-Y gastric bypass. J Am Coll Surg. 2018;225(4):e2-e3.

19.

Chou

Gordon

DB.

de Leon-Casasola

et al. Management of postoperative pain: a clinical practice guideline from the American pain Society, the American Society of regional anesthesia and pain medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131-157.doi:10.1016/j.jpain.2015.12.008

http://www.ncbi.nlm.nih.gov/pubmed/26827847

20.

McPherson

. Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing. American Society of Health-System Pharmacists; 2009.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB

Creating an Opioid Recommendation Card for Trainees: Methods,Use,and Impact

Abstract

Background

Methods

Results

Discussion

Keywords

Get full access to this article

References

Supplementary Material