From the 2018 HVPAA National Conference
Nathan Woody (UNC School of Medicine), Jessie Gilmore (UNC Hospitals), Jami Mann (UNC Hospitals), Matthew Nielsen (UNC School of Medicine), Clark Mccall (UNC School of Medicine), Brooke Chidgey (UNC School of Medicine), Peggy McNaull (UNC School of Medicine)
In 2017, UNC Medical Center, the Ambulatory Surgical Center, and the Hillsborough Hospital prescribed 857,993 opioid doses for post-procedural pain after discharge. There’s little published data on optimal number of pills to prescribe following procedures. This, with lack of education on the ramifications of unused opiates, often leads to overprescribing.
An interdisciplinary team was formed to respond to North Carolina’s opioid epidemic with experts from UNC’s Department of Anesthesiology, Pharmacy, and Urology. The team engaged hospital-wide surgical leaders to participate and frame the opioid stewardship program. The objectives of the interdisciplinary team include implementation of a Standard Opioid Prescribing Schedule (SOPS) with 50% or greater compliance in three surgical populations, develop best practice guidelines and standards for the prescription of opioids, and educate surgical service healthcare providers including surgeons and nurses on appropriate prescribing, storage, and disposal of opioid medications.
To develop baseline opioid prescription utilization data, the team generated a weekly report containing patients discharged from select surgical services in the chosen pilot populations and who were prescribed an opiate. The pilot populations included Urology, Gynecology, Pediatric Surgery, Pediatric Urology, Acute Care/Trauma Surgery, Plastic Surgery, and Pediatric Otolaryngology. Using this report, the team conducted telephone interviews approximately two weeks after discharge from the hospital to understand opioid usage, disposal, and patient education over a four-month period (7/1/17-11/15/17). Using the RedCap program, information was stored in a standard way and in a secure location. After the data collection period, the team conducted a comparative analysis between the number of prescribed opioid doses and number of doses consumed. Based on this, standard opioid prescribing recommendations were made using a +1 SD of the mean number of opioids consumed for each procedural population. After consultation and agreement of, the surgical service team leader for each pilot population, these recommendations were implemented. Post-implementation data collection is ongoing.
Of the 979 patients included in the study, 31% (n=306) completed the telephone interview. 81% (n=248) of the participating patients filled their opioid prescription ranging from 3 to 190 doses (SD=15) in 72 distinct procedural populations. While the average number of opioid doses prescribed was 26 per patient, average use was only 14, leaving 46% of the prescription unused. Post-implementation data is pending.
Based on our results, improvements can be made in opioid prescribing practices to minimize excess supply available for misuse, while appropriately treating postoperative pain. Implementation of a Standard Opioid Prescribing Schedule (SOPS) is projected to reduce the number of unused opioids by more than 48,000 doses in the pilot populations at UNC. Data collection and analysis are ongoing to further develop and understand the practice-based recommendations.
Implications for the Patient
This study attempts to understand patient pain requirements after surgery, specifically the use of opioid prescriptions. This study develops a data driven SOPS for over 72 procedures at UNC Medical Center. Using this study’s model, efforts are ongoing to engage additional patient populations to continue combating North Carolina’s opioid epidemic.