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  • Title: No refills: The durable impact of a multifaceted effort by surgical trainees to minimize the prescription of postoperative opioids.
    Author: Chiu AS, Freedman-Weiss MR, Jean RA, Cohen E, Yoo PS.
    Journal: Surgery; 2019 Nov; 166(5):758-763. PubMed ID: 31253416.
    Abstract:
    BACKGROUND: Surgeons have the opportunity to help offset the opioid epidemic by leading with practice changes. We sought to decrease the amount of opioid prescribed postoperatively through a multifaceted program. METHODS: A multipronged program was introduced in our hospital system, which included resident education on prescribing for postoperative analgesia, a change in the default number of opioid pills in an electronic medication order entry system, and the distribution of a guideline card of recommended postoperative opioid prescription amounts. The amount of opioid prescribed postoperatively between January 2016 and August 2018 was collected for the 10 most common short-stay (<48 hours) general surgery procedures. The 6 months prior to any intervention (pre-intervention) was compared to the last 6 months of data collection (post-intervention). RESULTS: In the study, 14,007 operations were captured, including 2,530 pre-intervention and 2,715 post-intervention. The average amount of postoperative opioid prescribed in the pre-intervention period was 207.1 morphine milligram equivalents; post-interventions, the average amount declined to 104.6 morphine milligram equivalents (P < .01). The opioid refill rate remained the same (3.3% pre-intervention vs 3.1% post-intervention, P = .76). CONCLUSION: A comprehensive program to eliminate the over-prescription of opioids decreased the amount of opioid prescribed by half, without a concurrent increase in opioid refills, demonstrating that simple measures can be used to deliver sustained and reproducible improvements in offering source control in the opioid epidemic.
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