A physician led consensus building intervention at a multi-specialty practice results in meaningful reduction of opioid prescriptions for post-operative patients

Abstract

Abstract Background Despite the known opioid crisis and momentum for opioid prescribing protocols in orthopedic surgery, there are no universal guidelines for procedure-specific opioid prescription amount, or duration of use. We report results of a single, brief quality improvement intervention to reduce opioid prescribing in a private practice setting. Methods Providers attended one two-hour Journal Club structured into three components: (1) epidemiology of opioid use; (2) literature review; and (3) sub-specialty workgroups to develop protocols for opioid naïve surgical patients (discharge prescription, refill allotment, and maximum duration). Morphine equivalents (MEQs) were calculated for all surgical patients for 10 months pre- (December 2017 – September 2018) and one year post-intervention (October 2018 – September 2019), including total MEQ prescribed, mean MEQ per prescription, mean MEQ per patient, and mean count of opioid prescriptions through 90 days post-operatively. Statistical quality control charts were used to assess impact and durability of the intervention. Results Thirty-three surgeons and mid-level providers with a DEA license participated (88% participation rate). There were 7,392 opioid prescriptions written in the pre-intervention period and 7,650 opioid prescriptions post-intervention (N=15,042), for 3,962 and 4,330 patients, respectively. A significant downward shift occurred for pre- and post-intervention prescriptions across all measures: mean monthly MEQ of 334,637 (sd = 25,517) to post- intervention mean MEQ of 233,913 (sd = 58,024, p<0.001); mean MEQs per prescription from 451 MEQs (sd =373) to 350 MEQs (sd = 301, p<0.001); mean MEQ per patient from 834 (sd =1,443) to 626 (sd = 1,158, p<0.001); and mean count of prescriptions from 1.86 (sd = 1.75) to 1.77 (sd = 1.66, p=0.0108). Conclusions A one time, physician-directed educational event, combined with consensus building and procedure-specific protocol development resulted in significant declines in opioid prescribing. At one year, the trend continued and there was not an increased patient refill demand. Level of Evidence Level V; quality improvement