Post-surgical discharge opioid prescribing, use and handling after introduction of a stewardship program
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Le résumé fourni par la source
SummaryOpioids are often used to provide postsurgical analgesia but may cause harm if used inappropriately. We introduced an opioid stewardship program in three Melbourne hospitals to reduce the inappropriate use of opioids after patient discharge. The program had four pillars: prescriber education, patient education, a standardised quantity of discharge opioids, and general practitioner (GP) communication. Following introduction of the program, we undertook this prospective cohort study. The study aimed to describe post-program discharge opioid prescribing, patient opioid use and handling, and the impact of patient demographics, pain and surgical treatment factors on discharge prescribing. We also evaluated compliance with the program components. We recruited 884 surgical patients from the three hospitals during the ten-week study period. Discharge opioids were dispensed to 604 (74%) patients, with 20% receiving slow-release opioids. Junior medical staff undertook 95% of discharge opioid prescribing, which was guideline-compliant for 78% of patients. Of the patients discharged with opioids, a GP letter was sent for only 17%. Follow-up at two weeks was successful in 423 (70%) patients and in 404 (67%) at three months. At the three-month follow-up, 9.7% of patients reported ongoing opioid use; in preoperatively opioid naïve patients, the incidence was 5.5%. At the two-week follow-up, only 5% reported disposal of excess opioids, increasing to 26% at three months. Ongoing opioid therapy at three months in our study cohort (9.7%; 39/404) was associated with preoperative opioid consumption and higher pain scores at the three-month follow-up. The introduction of the opioid stewardship program resulted in highly guideline-compliant prescribing, but hospital-to-GP communication was uncommon and opioid disposal rates were low. Our findings suggest that opioid stewardship programs can improve postoperative opioid prescribing, use and handling, but the realisation of these gains will require effective program implementation.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Post-surgical discharge opioid prescribing, use and handling after introduction of a stewardship program
- Date Crossref
- 20/06/2023
- Éditeur
- SAGE Publications
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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The Royal Melbourne Hospital Department of Anaesthesia and Pain Management pays non établi dans la noticeOrganisme public
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The University of Melbourne Department of Critical Care pays non établi dans la noticeUniversité ou école supérieure
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Royal Women's Hospital Department of Anaesthesia pays non établi dans la noticeÉtablissement de santé
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Peter MacCallum Cancer Centre pays non établi dans la noticeÉtablissement de santé
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School of Population and Global Health Centre for Epidemiology and Biostatistics pays non établi dans la noticeUniversité ou école supérieure
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Faculty of Medicine Methods and Implementation Support for Clinical Health (MISCH) Research Hub pays non établi dans la noticeUniversité ou école supérieure
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Department of Cancer Anaesthesia pays non établi dans la noticeInstitution
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Department of Pharmacy pays non établi dans la noticeInstitution
Department of Anaesthesia and Pain Management — The Royal Melbourne Hospital, Department of Critical Care — The University of Melbourne et Department of Anaesthesia — Royal Women's Hospital, avec 5 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.