Twin Cities Orthopedics opioid guidelines program reduced prescriptions after orthopedic surgery
Twin Cities Orthopedics in the Minneapolis/St. Paul area has significantly reduced pain medication prescriptions and improved the habits for safe disposal of unused medications while maintaining high patient satisfaction levels with implementation of an opioid guidelines program.
The three-phase program, which also helped build consensus among orthopedic surgeons in the practice, was launched in 2017 to evaluate opioid prescribing patterns within the group.
“We wanted to cut down on the amount of opiates patients were consuming and diminish the time that patients were taking opiates after surgery. Furthermore, we wanted to do this and still monitor their satisfaction with pain control and surgical outcome scores,” Gary Wyard, MD, chief medical officer and senior physician at Twin Cities Orthopedics (TCO), told Healio.com/Orthopedics. “We cared not only about how their pain was being taken care of, we cared about their general well-being.”
According to Wyard, who oversaw the TCO prescription protocols, physicians involved in the program identified a wide variability in the amount of opioids and morphine equivalent units that were prescribed following 13 specific procedures, which included knee and hip replacement, laminectomy, ACL repair and arthroscopy.
“[T]his large dosing variability among different surgeons made no sense,” Wyard said. “There was no science behind it; it was just habit.”
In addition, patients were taking less than 50% of the pills they were prescribed, which he said may lead to opioid prescriptions being misdirected.
“In other words, the excessive amounts of drugs may be misused by the general community and have adverse consequences that result in habitual use and/or eventual opioid addiction,” Wyard said.
Guidelines provide physician, patient resources
In response to these findings, TCO reviewed established guidelines that would provide resources for both physicians and patients. Physicians were provided prescription reference cards that listed the maximum recommended quantity of pills per episode of care and the appropriate dosage. The reference cards also explained to physicians the practice’s new protocols, which included:
- All physicians had to register with the Prescription Monitoring Program;
- Opioid prescriptions could not be provided if a patient had not been seen for more than 2 months;
- Physicians could not provide refills for pain flare-ups;
- Physicians could not provide early refills;
- Physicians could only prescribe short-acting medications; and
- Physicians were required to use alternative pain medication (acetaminophen, ibuprofen, Ultram [tramadol], etc.) and other measures, such as ice, physical therapy, counseling, etc., before prescribing opioids.
At office visits, patients also received a pamphlet that contained information about narcotics, what to expect after surgery, pain management strategies and proper disposal of medications.
Reduction in opioid use
When these guidelines were implemented, the group saw a reduction in the average number of pills prescribed, from 41 to 16 pills, and patient satisfaction with pain control was maintained at 89%, Wyard said.
“In our postoperative outpatient surgical patients, 46% now do not get any narcotics at all because we educate them by giving them information on pain control and we explain methods of disposing of their excess narcotics,” he said.
TCO continues to monitor the effect of its new opioid guidelines through patient surveys and plans to adjust the program as needed based on physician and patient feedback. Wyard said he hopes the program continues to reduce the role physicians have had in over-prescribing opioids after orthopedic surgery.
“The success of our program comes from having leadership and/or a physician champion changing the opioid-prescribing culture,” Wyard said. “You have to utilize respected physicians in the group to build consensus throughout the group on why and how those guidelines will be implemented.” – by Casey Tingle
Disclosure: Wyard reports no relevant financial disclosures.