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 SystemBrown 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 GuidelinesVu 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 GuidelinesHoward 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.