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Michigan OPEN

Publications

OPEN examines data, clinical practices and strategies to support better pain management, opioid stewardship, policy, treatment and care.

Assessment of a Quality Improvement Intervention to Decrease Opioid Prescribing in a Regional Health System

Brown CS, Vu JV, Howard RA, Gunaseelan V, Brummett CM, Waljee JF, Englesbe MJ. Assessment of a quality improvement intervention to decrease opioid prescribing in a regional health system. BMJ Quality & Safety. Published Online First: 16 September 2020. doi: 10.1136/bmjqs-2020-011295
  • The use of procedure-specific prescribing guidelines reduced statewide postoperative opioid prescribing by 50%.
  • Opioid consumption also decreased, while satisfaction and postoperative pain remained unchanged.
  • Leveraging the continuous quality improvement infrastructure to implement evidence-based opioid prescribing guidelines has had a meaningful impact on opioid prescription.

Statewide Implementation of Postoperative Opioid Prescribing Guidelines

Vu JV, Howard RA, Gunaseelan V, Brummett CM, Waljee JF, Englesbe MJ. Statewide Implementation of Postoperative Opioid Prescribing Guidelines. N Engl J Med. 2019;381(7):680-682. doi:10.1056/NEJMc1905045
  • Evidence-based prescribing guidelines reduced postoperative opioid prescription size across a statewide population without negatively affecting patient satisfaction or pain
  • Despite the reductions in prescription size and opioid use, there were no clinically important changes in satisfaction or pain scores
  • Mean prescription size decreased by 8 pills after the guidelines were released and opioid consumption also decreased by 3 pills

Reduction in Opioid Prescribing Through Evidence-Based Prescribing Guidelines

Howard R, Waljee J, Brummett C, Englesbe M, Lee J. Reduction in Opioid Prescribing Through Evidence-Based Prescribing Guidelines. JAMA Surg. 2018;153(3):285-287. doi:10.1001/jamasurg.2017.4436
  • Prior to the intervention, post-laparoscopic cholecystectomy (gall bladder removal surgery) opioid prescribing exceeded patient pain management needs by approximately 88%, based on patient- reported opioid use.
  • Implementation of evidence-based prescribing guidelines reduced post-laparoscopic cholecystectomy opioid prescribing by 63% without increasing the need for medication refills.
  • Patients who received smaller opioid prescriptions after the intervention reported using fewer opioids, indicating that anchoring and adjustment heuristics may impact patient opioid use.