Introduction
Opioid overprescription is a significant concern in postoperative care, especially following surgeries such as total hip arthroplasty (THA) and total knee arthroplasty (TKA). A recent study published in BMJ Open Quality outlines a successful quality improvement (QI) initiative aimed at reducing opioid overprescription in these contexts. This blog explores the study's findings and offers insights for practitioners seeking to improve their prescribing practices.
Understanding the Problem
Data from the study indicated that approximately 32% of opioids prescribed at discharge remained unused, posing a risk for diversion and misuse. This issue is particularly pressing given the ongoing opioid crisis, where a significant portion of opioid-related deaths are linked to prescribed medications. The study aimed to address this by implementing a quality improvement bundle to reduce the average oral morphine equivalents (OME) dispensed at discharge by 15%.
Quality Improvement Bundle
The intervention consisted of several key components:
- Patient and Provider Education: Educational materials were developed for both patients and healthcare providers, focusing on pain management strategies and safe opioid use.
- Standardized Prescribing Algorithm: A standardized pain management protocol was introduced, which included specific guidelines for opioid prescriptions based on patient age and surgical procedure.
- Automated Discharge Prescriptions: The use of autopopulated part-fill prescriptions with expiry dates was implemented to ensure consistency and reduce the potential for overprescription.
Results and Implications
The study successfully reduced the mean OME dispensed by 26.3%, surpassing the initial target. Importantly, this reduction did not negatively impact patient satisfaction or increase the need for additional opioid prescriptions. The intervention demonstrated that a structured, data-driven approach could effectively address opioid overprescription without compromising patient care.
Practical Applications for Practitioners
For practitioners, the study highlights the importance of adopting a multimodal approach to pain management. By integrating educational initiatives with standardized prescribing practices, healthcare providers can significantly reduce opioid overprescription. Additionally, leveraging technology to automate and standardize discharge prescriptions can enhance the sustainability of these interventions.
Encouraging Further Research
While the study provides a robust framework for reducing opioid overprescription, further research is needed to explore its applicability in different surgical contexts and patient populations. Practitioners are encouraged to engage in ongoing research and quality improvement efforts to refine and adapt these strategies to their specific clinical settings.
To read the original research paper, please follow this link: Successful implementation of a quality improvement bundle to reduce opioid overprescribing following total hip and knee arthroplasty.
