Optimizing Discharge Opioid Prescribing Practices After Mastectomy With Immediate Reconstruction
A quality improvement initiative was conducted to provide guidelines for opioid prescribing following mastectomy with immediate reconstruction. Patients undergoing mastectomy with concurrent tissue expander reconstruction were surveyed at their first postoperative visit to determine use of pain medi...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-06-01
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| Series: | Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2542454819300323 |
| _version_ | 1818924371113148416 |
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| author | Alaa Sada, MD Cornelius A. Thiels, DO Marcia K. Britain, APRN Amela Dudakovic, PA Whitney J. Bergquist, PharmD Sarah R. Nickel, PA Melissa J. Moran, APRN Jorys Martinez-Jorge, MD James W. Jakub, MD |
| author_facet | Alaa Sada, MD Cornelius A. Thiels, DO Marcia K. Britain, APRN Amela Dudakovic, PA Whitney J. Bergquist, PharmD Sarah R. Nickel, PA Melissa J. Moran, APRN Jorys Martinez-Jorge, MD James W. Jakub, MD |
| author_sort | Alaa Sada, MD |
| collection | DOAJ |
| description | A quality improvement initiative was conducted to provide guidelines for opioid prescribing following mastectomy with immediate reconstruction. Patients undergoing mastectomy with concurrent tissue expander reconstruction were surveyed at their first postoperative visit to determine use of pain medication, satisfaction, and refill rates. Opioid prescriptions were converted to total oral morphine milligram equivalents (MMEs). Guidelines for postdischarge prescriptions were developed. During phase I, 16 patients were surveyed to determine baseline prescribed MMEs and rate of satisfaction. A guideline was subsequently developed to standardize postdischarge prescribing (550 MMEs prescribed average risk vs 900 MMEs high risk), and the survey was repeated (phase II). Median 210 MMEs were used. Of the 23 patients, 1 required a refill, 83% were highly satisfied, and 77% of opioids were unused. Guidelines were further revised to limit prescribed opioids (290 MME average risk vs 450 MME high risk), and the survey was repeated (phase III). A median of 118 MMEs was used. Of the 22 patients, 5 required refills, 73% were highly satisfied, and 53% of opioids were unused. Phase IV included 27 patients. A median of 98 MMEs was used. Two patients required refills, 93% were highly satisfied, and 58% of opioids were unused. Our finding showed that there is significant overprescription of opioids after elective breast surgery. Practice guidelines can reduce the amount of opioids prescribed. Reducing excess opioids available in the community is a noble goal; however, it must be done cautiously, as decreased patient satisfaction can be an unintended consequence. |
| first_indexed | 2024-12-20T02:24:16Z |
| format | Article |
| id | doaj.art-0ff593d454e048b4a36eff0bbc25ac33 |
| institution | Directory Open Access Journal |
| issn | 2542-4548 |
| language | English |
| last_indexed | 2024-12-20T02:24:16Z |
| publishDate | 2019-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| spelling | doaj.art-0ff593d454e048b4a36eff0bbc25ac332022-12-21T19:56:45ZengElsevierMayo Clinic Proceedings: Innovations, Quality & Outcomes2542-45482019-06-0132183188Optimizing Discharge Opioid Prescribing Practices After Mastectomy With Immediate ReconstructionAlaa Sada, MD0Cornelius A. Thiels, DO1Marcia K. Britain, APRN2Amela Dudakovic, PA3Whitney J. Bergquist, PharmD4Sarah R. Nickel, PA5Melissa J. Moran, APRN6Jorys Martinez-Jorge, MD7James W. Jakub, MD8Department of Surgery, Mayo Clinic, Rochester, MNDepartment of Surgery, Mayo Clinic, Rochester, MNDivision of Breast, Endocrine, Metabolic and GI Surgery, Mayo Clinic, Rochester, MNDivision of Plastic Surgery, Mayo Clinic, Rochester, MNDepartment of Pharmacy, Mayo Clinic, Rochester, MNDivision of Breast, Endocrine, Metabolic and GI Surgery, Mayo Clinic, Rochester, MNDivision of Breast, Endocrine, Metabolic and GI Surgery, Mayo Clinic, Rochester, MNDivision of Plastic Surgery, Mayo Clinic, Rochester, MNDepartment of Surgery, Mayo Clinic, Rochester, MN; Division of Breast, Endocrine, Metabolic and GI Surgery, Mayo Clinic, Rochester, MN; Correspondence: Address to James W. Jakub, MD, FACS, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.A quality improvement initiative was conducted to provide guidelines for opioid prescribing following mastectomy with immediate reconstruction. Patients undergoing mastectomy with concurrent tissue expander reconstruction were surveyed at their first postoperative visit to determine use of pain medication, satisfaction, and refill rates. Opioid prescriptions were converted to total oral morphine milligram equivalents (MMEs). Guidelines for postdischarge prescriptions were developed. During phase I, 16 patients were surveyed to determine baseline prescribed MMEs and rate of satisfaction. A guideline was subsequently developed to standardize postdischarge prescribing (550 MMEs prescribed average risk vs 900 MMEs high risk), and the survey was repeated (phase II). Median 210 MMEs were used. Of the 23 patients, 1 required a refill, 83% were highly satisfied, and 77% of opioids were unused. Guidelines were further revised to limit prescribed opioids (290 MME average risk vs 450 MME high risk), and the survey was repeated (phase III). A median of 118 MMEs was used. Of the 22 patients, 5 required refills, 73% were highly satisfied, and 53% of opioids were unused. Phase IV included 27 patients. A median of 98 MMEs was used. Two patients required refills, 93% were highly satisfied, and 58% of opioids were unused. Our finding showed that there is significant overprescription of opioids after elective breast surgery. Practice guidelines can reduce the amount of opioids prescribed. Reducing excess opioids available in the community is a noble goal; however, it must be done cautiously, as decreased patient satisfaction can be an unintended consequence.http://www.sciencedirect.com/science/article/pii/S2542454819300323 |
| spellingShingle | Alaa Sada, MD Cornelius A. Thiels, DO Marcia K. Britain, APRN Amela Dudakovic, PA Whitney J. Bergquist, PharmD Sarah R. Nickel, PA Melissa J. Moran, APRN Jorys Martinez-Jorge, MD James W. Jakub, MD Optimizing Discharge Opioid Prescribing Practices After Mastectomy With Immediate Reconstruction Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| title | Optimizing Discharge Opioid Prescribing Practices After Mastectomy With Immediate Reconstruction |
| title_full | Optimizing Discharge Opioid Prescribing Practices After Mastectomy With Immediate Reconstruction |
| title_fullStr | Optimizing Discharge Opioid Prescribing Practices After Mastectomy With Immediate Reconstruction |
| title_full_unstemmed | Optimizing Discharge Opioid Prescribing Practices After Mastectomy With Immediate Reconstruction |
| title_short | Optimizing Discharge Opioid Prescribing Practices After Mastectomy With Immediate Reconstruction |
| title_sort | optimizing discharge opioid prescribing practices after mastectomy with immediate reconstruction |
| url | http://www.sciencedirect.com/science/article/pii/S2542454819300323 |
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