Faculty Collaboration Database

Optimizing discharge opioid prescribing in trauma patients: A quasi-experimental study. Surgery 2023 Mar;173(3):794-798

Date

11/13/2022

Pubmed ID

36371358

DOI

10.1016/j.surg.2022.07.037

Scopus ID

2-s2.0-85141795445 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

BACKGROUND: Patients prescribed higher opioid dosages are at increased risk of overdose and death without added pain reduction. Increases in opioid prescribing continue to fuel the epidemic. We hypothesized a comprehensive guideline to standardize opioid prescribing would decrease postdischarge dosages for patients experiencing trauma without requiring additional refills.

METHODS: This quasiexperimental study compared opioid prescribing by trauma providers before and after the implementation of a departmental guideline on April 1, 2019, aimed at aligning opioid prescription patterns with Centers for Disease Control and Prevention recommendations. Patients prescribed opioids before implementation were the control group, whereas patients prescribed opioids after were the intervention group. The primary outcome was the proportion of patients receiving ≥50 morphine milligram equivalents per day.

RESULTS: We identified 293 and 280 patients experiencing trauma in the control and intervention groups, respectively. There were no differences between the groups' Injury Severity Score (P = .69) or the frequency of having a procedure performed (P = .80). Total morphine milligram equivalents and maximum morphine milligram equivalents per day were 16% and 25% lower, respectively, in the intervention group compared with the control group (P < .001). The proportion of trauma patients prescribed ≥50 morphine milligram equivalents per day at discharge decreased from 57% to 18% after implementation (P < .001). The proportion of trauma patients prescribed ≥90 morphine milligram equivalents per day also decreased, from 37% to 14% (P < .001). There was no significant increase in the frequency of refill requests (P = .105) or refill prescriptions (P = .099) after discharge.

CONCLUSION: A departmental guideline aimed at optimizing opioid prescription patterns successfully lowers the amount of morphine milligram equivalents prescribed to trauma patients and improves compliance with Centers for Disease Control and Prevention recommendations.

Author List

Tyson K, Karam BS, Peppard WJ, Morris R, Murphy P, Elegbede A, Schroeder M, Somberg L, Trevino CM

Authors

Anuoluwapo F. Elegbede MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Rachel S. Morris MD Assistant Professor in the Surgery department at Medical College of Wisconsin
William J. Peppard PharmD Trauma/Surgical Critical Care Pharmacist in the Pharmacy department at Froedtert Hospital
Mary Elizabeth Schroeder MD Associate Professor in the Surgery department at Medical College of Wisconsin
Colleen Trevino PhD APP Clinical Dir Inpatient 2 in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aftercare
Analgesics, Opioid
Humans
Morphine Derivatives
Pain, Postoperative
Patient Discharge
Practice Patterns, Physicians'