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The butterfly effect: How an outpatient quality improvement project affected inpatient opioids prescribing habits
Journal article   Open access   Peer reviewed

The butterfly effect: How an outpatient quality improvement project affected inpatient opioids prescribing habits

William J. Lorentzen, Natalie Perez, Colette Galet and Lauren D. Allan
Surgery in practice and science, Vol.11, 100139
12/01/2022
DOI: 10.1016/j.sipas.2022.100139
PMID: 36531565
url
https://doi.org/10.1016/j.sipas.2022.100139View
Published (Version of record) Open Access

Abstract

Background: The aim of the study was to assess whether a quality improvement project focused on providers ' education of responsible opioid prescribing, creating order sets to facilitate pre- and post-operative adjunct use, and decreasing the number of opioids prescribed following elective outpatient surgery affected opioid prescribing habits and the use of adjunct pain medication on the inpatient Emergency General Surgery (EGS) service. Methods: Inpatient EGS opioid prescribing habits following laparoscopic cholecystectomy, laparoscopic and open inguinal hernia repair, or open umbilical hernia repair during the pre- and post-Acute Care Surgery DivisionQuality Improvement (QI) periods were recorded retrospectively. Demographics, type and dose of opioids, and non-opioid adjuncts prescribed were collected. Opioids were converted to oral morphine equivalents (OME). Pre- and post-QI data were compared. Post-QI discharge opioids prescribed were compared to reported use of opioids. Patients ' rating of pain management is reported. Results: One hundred twenty-two and 62 patients were included during the pre- and post- QI periods, respectively. Post-QI, opioid prescribing decreased, and adjunct prescribing increased (31.1% vs. 72.6%; p < 0.001) at discharge. Interestingly, higher 24 h pre-discharge OME was associated with a higher OME prescribed at discharge (B = 1.255 [0.377 - 2.134]; p = 0.005). Of the 47 EGS patients who followed up in clinic post-ACS QI, 89.4% rated their pain management as excellent/good, 8.5% as fair, and 2.1% as poor. Conclusions: Implementation of a multifaceted approach to decrease opioid prescribing in the outpatient setting organically affected opioid prescribing habits at discharge for inpatients.
 Life Sciences & Biomedicine Science & Technology Surgery

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