Optimising discharge opioid prescription for post-operative patients

Aim Statement

Reduce the number of patients that develop long term opioid use after surgery

Goals

By December 2020 reduce by 20% number of opioid naive patients discharged after surgery with:

• Long acting or extended release opioids • Inconsistencies in opioid discharge prescription and

inpatient doses given 24 hours prior to discharge

Goals

By July 2021 reduce by 30% the nº of patients discharged

• Without a postoperative pain management plan in the discharge summary

• Continue to take opioids 6 weeks after surgery

By October 2021 at least 30% of the patients to receive a pain management discharge leaflet or watched an educational video

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Dr Enrique Collantes Celador Specialist in Anaesthesia & Pain Medicine Email: enriquecollantes@doctors.org.uk ECLP Cohort 25

Plans to Sustain Change• Training junior doctors at beginning of each term• APS & pharmacy to police prescribing& support JMO• Ongoing review of project at “Quality of Opioid Use

Committee” monthly meetings• Introduction of patient leaflet and video• Continue to collect data, 12 monthly audits &

disseminate results to staff• Try to develop a Subacute Pain Clinic

Interventions Developed

Reduction of opioid pack sizesLimits on prescribed opioid quantities Health professional education & resident appSupport for GPsDischarge prescribing cards

Analgesia discharge reference guidance

Document with the expected recovery time & duration of opioid use for all surgeries

Pain management template for patients discharge summary

Plans to Share Change• Submit to the ACI Innovation Exchange (2021) • Enter into CCLHD Quality Award - February 2021• Aim to publish in Journal of Hospital Medicine • Present at Australian Pain Society Meeting - 2021

Team Members

Project Sponsor: CCLHD Supervisor: A/Prof B.Murnion (Head of Addiction Medicine)Pharmacy: D.Gilbert (Director), A.Tagaroulias C.McCormack, R.Tarrant, T.Ngo, F.DeeryPalliative Care: J MacKintosh (CNC)Acute Pain Team: L.Gundry (CNC) & Dr A.Watt (Lead)Service Support Officer: I.PurcellConsumer (junior doctors): Dr L.May, Dr S.Desai, Dr S.Williams

Results

Reducing Opioid Pack Sizes - Number of Oxycodone Tablets Dispensed on Discharge

Discharge of 40 Patients in April 2019

DiscussionOptimising discharge opioid prescribing, patient education and communication with primary care is essential to achieve good outcomes, patient satisfaction, prevention ofprolonged opioid use and medication related harm

Outcome of Project• Modest Improvement but expecting improvements in

12 months (COVID interrupted the project)• Reduction in the nº of patients that develop long term

opioid use & medication related harm after surgery will have a cost saving effect in the community

References• Anaesthesia & Intensive Care 2019; 47(6):548-552• Faculty of Pain Medicine of Australia • https://www.hospitalmedicine.org/MI• https://www.uptodate.com• Society of Hospital Pharmacists of Australia