OrthoCarolina emphasizes patient education for reducing opioid prescriptions
About 4 to 5 years ago, surgeons at OrthoCarolina recognized that patients were misusing opioid medications prescribed after a procedure. As a way to address this problem, OrthoCarolina implemented guidelines for providers that outlined an appropriate approach to narcotic prescribing.
“In addition to that, we created some narcotic-dosing suggestion guidelines with amounts and frequencies in keeping with what was considered ... morphine milligram-equivalent maximums,” H. Yates Dunaway, MD, from OrthoCarolina, told Healio.com/Orthopedics.
Narcotic prescription guidelines
These guidelines, which are now in line with protocols mandated by the state of the North Carolina, limit the number of narcotics prescribed, with a 5-day limit for an initial evaluation and a 7-day limit postoperatively, according to Dunaway. He added they have created three CME lectures for their providers on the pathology of pain management and narcotic prescribing.
“The CDC has stated that acute pain is thought to be a 90-day process and then after 90 days, it is thought to be a chronic pain management problem,” Dunaway said. “We use that number ... as our guideline as to when we should start to taper patients from an acute pain situation to more of a chronic pain management situation.”
Patient education is key
One key aspect of reducing opioid prescriptions involved patient education, according to Dunaway. This was achieved by providing patients with information sheets on appropriate use of narcotics and OrthoCarolina’s position on utilizing narcotics, which Dunaway said emphasizes “the multimodal approach to anesthesia for surgery and other more invasive procedures.” He added they have begun to incorporate narcotic management as part of their patient preoperative optimization protocol and encourage providers to utilize the pain management toolkit available at the American Academy of Orthopaedic Surgeons’ website which provides guidelines and information for patients and providers on how to manage acute pain.
“I think [patient education has] been key because that has helped us with not getting a lot of pushback and patients understanding and being appreciative of being informed of what the situation is,” Dunaway said.
At the beginning of implementing these guidelines, Dunaway noted they were concerned about maintaining patient satisfaction. However, he said that they have not seen a decline in patient satisfaction scores.
“As far as outcomes, and this is no science, this is just as sense that there has not been any change in the outcomes either positively or negatively,” Dunaway said.
Carolinas Opioid Reduction Effort project
In 2018, OrthoCarolina and the OrthoCarolina Research Institute implemented the Carolinas Opioid Reduction Effort (CORE) project, which included the nation’s first comprehensive study designed to assess the efficacy of opioid-free pain management for patients. As a part of this project, Nady Hamid, MD, and colleagues performed a pilot study that showed patients experienced equal or less pain when enrolled in an opioid-free protocol following shoulder replacement surgery compared with a traditional opioid-centered medication protocol.
Currently, Hamid and colleagues are performing a level 1, randomized controlled trial involving 700 patients and approximately 30 investigators which they hope will provide opioid-free protocols to recommend to orthopedic surgeons around the country.
“We are hopeful that we can adopt a lot of what [Hamid is] trying to do,” Dunaway said. “It is primarily shoulder surgery, but a bunch of these [studies] have other subspecialties involved [and] we are hoping to spread that out clinic wide once we get the findings.” – by Casey Tingle
Disclosure: Dunaway reports no relevant financial disclosures.