Opioid Stewardship Program May Improve Opioid Prescribing After Orthopedic Surgery

A health system-wide opioid stewardship program may have a positive influence on opioid prescribing habits after orthopedic surgery.

LAS VEGAS – A health system-wide opioid stewardship program may have a positive influence on opioid prescribing habits after orthopedic surgery, according to study results presented at PAINWeek 2019 held September 3-7 in Las Vegas, Nevada.

The program, Novant Health’s Opioid Stewardship Program, focuses on 4 key areas: improved postoperative prescribing practices, risk assessment, risk mitigation, and screening of patients with opioid use disorder for hepatitis C and HIV. The researchers identified orthopedic surgery as the surgical specialty associated with the greatest potential for improving postoperative prescribing practices.

The study included all prescriptions generated from the electronic health record that were linked with a discharge surgical encounter. The researchers excluded participants undergoing spine surgery or with an active oncologic diagnosis. The program aimed to reduce postoperative prescriptions by 90% of initial levels (ie, dose <350 morphine milligram equivalents [MME]).

The program introduced order sets for orthopedic surgery that included options for preemptive analgesia and multimodal therapy following surgery. Posters highlighting examples of prescriptions <350 MME were placed in clinician alcoves in surgical areas. Members of the workgroup provided education material to the Orthopedic Best Practice Exchange team, and the electronic medical record library of opioid prescriptions was updated from the default 10-day supply of opioids to include 5- and 7-day supply options.

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At baseline (January 2018), 60% of postsurgery prescriptions were ≤350 MME. After program implementation, this rate increased to 88% in April 2029. In February 2019 and March 2019, 92% and 90% of all prescriptions were ≤350 MME, respectively. The average goal compliance for the February 2019 to March 2019 period ranged from 67% to 99% from one facility to another.

“Future efforts to improve prescribing and pain control include utilization of a multimodal dashboard, an orthopedics Enhanced Recovery after Surgery program, and enhanced discharge education including guidance on tapering opioids and continuation of non-opioid agents,” noted the researchers.

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Meyer S, Bridgman B, Edwards B, Uhl K. Impact of a health system wide opioid stewardship program on prescribing practices following orthopedic surgery. Presented at: PAINWeek 2019; September 3-7, 2019; Las Vegas, NV. Poster 133.