Successful implementation of a quality improvement bundle to reduce opioid overprescribing following total hip and knee arthroplasty
Background Opioid overprescribing is commonplace after total hip (THA) and total knee arthroplasty (TKA). Preliminary data demonstrated that approximately 32% of the opioids prescribed at discharge from our hospital following THA and TKA remain unused. This is a concern given that unused prescribed...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-11-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/12/4/e002360.full |
| _version_ | 1797365963589419008 |
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| author | Daniel Cohen Caroline Jones Samuel Yoon Sarah Ward Vivian Law Bokman Chan Shawna Singh Angelo Papachristos Elizabeth Logan Priscilla Rubio-Reyes Kristen Terpstra |
| author_facet | Daniel Cohen Caroline Jones Samuel Yoon Sarah Ward Vivian Law Bokman Chan Shawna Singh Angelo Papachristos Elizabeth Logan Priscilla Rubio-Reyes Kristen Terpstra |
| author_sort | Daniel Cohen |
| collection | DOAJ |
| description | Background Opioid overprescribing is commonplace after total hip (THA) and total knee arthroplasty (TKA). Preliminary data demonstrated that approximately 32% of the opioids prescribed at discharge from our hospital following THA and TKA remain unused. This is a concern given that unused prescribed opioids are available for diversion and may result in misuse and abuse.Methods Pre-intervention data were collected between 1 November 2018 and 10 December 2018. An intervention bundle was then introduced, including education of patients and providers, a standardised pain management algorithm and an autopopulated discharge prescription. The aim of this quality improvement initiative was to reduce the amount of opioid (average oral morphine equivalents (OME)) dispensed (based on the discharge prescription provided) following THA and TKA at our institution by 15% by 1 April 2019.Design Using an interrupted time series design, the outcome measure was the amount of opioid (OME) dispensed from the discharge prescription provided. Process measures included the percentage of autopopulated discharge prescriptions, the percentage of patients receiving education at discharge and the percentage of nurses and residents receiving standardised education. Balancing measures included patient satisfaction with postoperative pain management, and the percentage of patients filling the second half of the part-fill or requiring a subsequent opioid prescription.Results With 600 patients identified, mean OME dispensed at discharge was reduced by 26.3% (from 522.2 to 384.9 mg) after our interventions started. Utilisation of autopopulated part-fill prescriptions was 95.8%. There was no change in patient satisfaction nor in the proportion of patients requiring an additional opioid prescription post-intervention. Only 39% of patients filled the second half of the part-fill prescription post-intervention.Conclusions Mean OME dispensed at discharge per patient was reduced with no change in patient satisfaction after introduction of the intervention bundle. |
| first_indexed | 2024-03-08T16:56:28Z |
| format | Article |
| id | doaj.art-04c4f455c9d4438480230c4f223f34c3 |
| institution | Directory Open Access Journal |
| issn | 2399-6641 |
| language | English |
| last_indexed | 2024-03-08T16:56:28Z |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj.art-04c4f455c9d4438480230c4f223f34c32024-01-04T22:05:08ZengBMJ Publishing GroupBMJ Open Quality2399-66412023-11-0112410.1136/bmjoq-2023-002360Successful implementation of a quality improvement bundle to reduce opioid overprescribing following total hip and knee arthroplastyDaniel Cohen0Caroline Jones1Samuel Yoon2Sarah Ward3Vivian Law4Bokman Chan5Shawna Singh6Angelo Papachristos7Elizabeth Logan8Priscilla Rubio-Reyes9Kristen Terpstra108 Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio, USAHealth Systems Research and Ethics, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya1 Sydney School of Veterinary Science, New South Wales, Sydney, AustraliaDivision of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USASt Michael`s Hospital, Toronto, Ontario, CanadaAnaesthesia, St. Michael`s Hospital, Toronto, Ontario, CanadaOrthopedics, St Michael`s Hospital, Toronto, Ontario, CanadaOrthopedics, St Michael`s Hospital, Toronto, Ontario, CanadaSurgery and Critical Care, St Michael`s Hospital, Toronto, Ontario, CanadaPharmacy, St Michael`s Hospital, Toronto, Ontario, CanadaTrauma & Neurosurgery ICU, St Michael`s Hospital, Toronto, Ontario, CanadaBackground Opioid overprescribing is commonplace after total hip (THA) and total knee arthroplasty (TKA). Preliminary data demonstrated that approximately 32% of the opioids prescribed at discharge from our hospital following THA and TKA remain unused. This is a concern given that unused prescribed opioids are available for diversion and may result in misuse and abuse.Methods Pre-intervention data were collected between 1 November 2018 and 10 December 2018. An intervention bundle was then introduced, including education of patients and providers, a standardised pain management algorithm and an autopopulated discharge prescription. The aim of this quality improvement initiative was to reduce the amount of opioid (average oral morphine equivalents (OME)) dispensed (based on the discharge prescription provided) following THA and TKA at our institution by 15% by 1 April 2019.Design Using an interrupted time series design, the outcome measure was the amount of opioid (OME) dispensed from the discharge prescription provided. Process measures included the percentage of autopopulated discharge prescriptions, the percentage of patients receiving education at discharge and the percentage of nurses and residents receiving standardised education. Balancing measures included patient satisfaction with postoperative pain management, and the percentage of patients filling the second half of the part-fill or requiring a subsequent opioid prescription.Results With 600 patients identified, mean OME dispensed at discharge was reduced by 26.3% (from 522.2 to 384.9 mg) after our interventions started. Utilisation of autopopulated part-fill prescriptions was 95.8%. There was no change in patient satisfaction nor in the proportion of patients requiring an additional opioid prescription post-intervention. Only 39% of patients filled the second half of the part-fill prescription post-intervention.Conclusions Mean OME dispensed at discharge per patient was reduced with no change in patient satisfaction after introduction of the intervention bundle.https://bmjopenquality.bmj.com/content/12/4/e002360.full |
| spellingShingle | Daniel Cohen Caroline Jones Samuel Yoon Sarah Ward Vivian Law Bokman Chan Shawna Singh Angelo Papachristos Elizabeth Logan Priscilla Rubio-Reyes Kristen Terpstra Successful implementation of a quality improvement bundle to reduce opioid overprescribing following total hip and knee arthroplasty BMJ Open Quality |
| title | Successful implementation of a quality improvement bundle to reduce opioid overprescribing following total hip and knee arthroplasty |
| title_full | Successful implementation of a quality improvement bundle to reduce opioid overprescribing following total hip and knee arthroplasty |
| title_fullStr | Successful implementation of a quality improvement bundle to reduce opioid overprescribing following total hip and knee arthroplasty |
| title_full_unstemmed | Successful implementation of a quality improvement bundle to reduce opioid overprescribing following total hip and knee arthroplasty |
| title_short | Successful implementation of a quality improvement bundle to reduce opioid overprescribing following total hip and knee arthroplasty |
| title_sort | successful implementation of a quality improvement bundle to reduce opioid overprescribing following total hip and knee arthroplasty |
| url | https://bmjopenquality.bmj.com/content/12/4/e002360.full |
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