M. R. Freedman-Weiss1, A. S. Chiu1, D. R. Heller1, V. Kurbatov1, P. S. Yoo1 1Yale University School Of Medicine,Surgery,New Haven, CT, USA
Introduction:
Prescription opioids are a main contributor to the current opioid epidemic as leftovers often get diverted for non-medical use. Surgeons are known to dispense far more opioid pills than are needed to treat pain. In academic institutions, junior residents (PGY-1, 2) write most postoperative prescriptions. Few residents receive education on opioids, but trainees who did, cited opioid dosage recommendations as the most useful educational point. Utilizing publsihed data on actual postoperative opioid use, we developed a card of recommendations for surgical residents to use when prescribing postoperative analgesia. We studied the impact of this initiative and the value of the card, paying particular interest in junior resident use.
Methods:
A pocket-sized postoperative analgesia guideline card was developed, comprising specific recommended opioid doses for common general-surgical procedures, general guidelines for postoperative analgesia, instructions for Narcan use, an equianalgesic opioid chart, and smartphrases in the electronic medical record for use as patient instructions on opioid use, safety, and disposal. The specific recommended doses were based on published data on actual postoperative opioid use and were approved by experienced surgeons from each included specialty. The tool was distributed to all general surgery housestaff at a university-affiliated hospital. Following the distribution of the card, an anonymous electronic survey (Qualtrics Survey Software) regarding its use and impact was distributed. Descriptive statistics were used for all analyses.
Results:
Of 85 trainees, 62 (72.9%) responded to the survey in full. Fifty respondents (80.6%) received the opioid guideline card, including 16 PGY-1’s and 10 PGY-2’s. Of responding PGY-1 and PGY-2 trainees who received the card, 75% and 60% respectively use it, with 46% of responding junior residents accessing the tool on a daily-to-weekly basis. Overall, 81.6% of included residents reported changing their opioid prescribing practices because of this intitative and 89.8% believe the card should continue to be distributed and used. The most valuable aspects of the card were the specific dosage recommendations (53.1%), the guidelines for analgesia after inpatient stays (40.8%), and the smartphrases for patient discharge instructions (28.6%).
Conclusion:
An evidenced-based guideline for postoperative analgesia, including specific recommendations for opioid doses after common surgical procedures, is useful for surgical residents, specifically junior residents. Nearly all residents who received this card report that is has influenced their prescribing practices and advise its continued distribution and use. A comprehensive guideline for postoperative analgesia should be considered for wide-use, specifically among junior residents at training hospitals. Its impact on offsetting the over-prescription of postoperative opioids should be studied further.