1 Assessment of a Standardized Discharge Prescription Implemented to Prevent Excess Opioid Use Post-Surgery: An Opioid Stewardship Strategy

Abstract

Background Excessive prescribing of postoperative opioids is a recognized contributor to opioid misuse and related harms. As part of an Ontario provincial initiative to address the issue, a standardized discharge prescription was implemented for patients undergoing day surgery. The discharge prescription consisted of 20 hydromorphone tablets prescribed as two part-fills of 10 tablets, to be dispensed 3 days apart. Objective(s) Primary: To evaluate the impact of reducing the quantity of opioids prescribed and determine the effect of using part-fills on pain control. Secondary: To assess the feasibility of implementing follow-up calls on the clinical pharmacy technician’s (CT) daily workflow. Methods Prior to the implementation of this quality improvement (QI) initiative, it was standard of care for nurses to call patients 24 hours post-surgery. In the new process, CTs made an additional follow-up call to patients who received the prescription on day 7 using a standardized questionnaire. Outcomes included number of hydromorphone tablets consumed, number of patients who filled the second part-fill, pain score on day 7 assessed with a 5-point scale (0-no pain, 5-difficult to manage pain), and average time required to conduct the calls per day. Results Between November 2019 and March 2020, 47 patients received a CT-led follow-up call. Of these 47 patients, 38 received the standardized discharge prescription without alterations by prescribers. At day 7 post-surgery, 29% of 970 hydromorphone tablets were consumed with an average of 6 tablets consumed per patient. Eighteen-percent of patients filled the second part-fill, 9% consumed all hydromorphone prescribed and 34% did not consume any hydromorphone tablets. Patients reported an average pain score of 1.6 on a 5-point scale. The average time for the CT follow up call was 29 minutes per day (0.01 Full-Time Equivalent of CT per day). Conclusion(s) Reducing the quantity of opioids prescribed and using part-fills in a standardized post-surgery discharge prescription reduced the availability of opioids in the community without compromising pain relief. Follow-up calls were also feasible to incorporate into the daily workflow of CTs.