Simon C. Mears
In 2016, as the opioid epidemic in the United States was becoming more widely recognized, the Orthopaedic Surgery Department at the University of Arkansas for Medical Sciences formed a committee to identify ways to decrease its opioid prescription rates.
“We started by questioning everybody in the department, including the mid-levels and the residents and the attendings, about what they were prescribing and what they were prescribing for different procedures and what their needs were,” Simon C. Mears, MD, safety and quality officer of the Department of Orthopaedic surgery at University of Arkansas for Medical Sciences, told Healio.com/Orthopedics. “We found out that there was a lot of variation in what people were prescribing, even for individual procedures, and that there was not standardization and that people wanted more education about this.”
Implement ation of recommendations
Mears said they set up educational courses with a well-known pain medicine doctor and created opioid prescription recommendations for small, moderate and large surgeries based off of information from the American Academy of Orthopaedic Surgeons opioid tool kit.
“At the time, we used a 20/40/60 rule as the maximum number of tablets that you could give for small, moderate or large procedures,” Mears said. “This was more than what the AAOS tool kit had but at the time, it seemed like a reduction in what we were doing.”
He added they recommended that prescriptions be written for one tablet every 6 hours as needed for pain and that prescribers only write one narcotic prescription per patient. They also educated patients on pain before surgery, encouraged patients to decrease opioid use prior to elective surgery and discussed alternative therapies and supplementary medicines, such as anti-inflammatories, acetaminophen, ice and elevation, according to Mears.
“People do not understand the difference between or even what an anti-inflammatory is. They do not know what acetaminophen is,” Mears said. “So, it takes some education and talking to people who can take medicines, such as Aleve and ibuprofen, and how long you can take it [and] how you can work that into a pain regimen so you can take less narcotics.”
Reduction in prescriptions, refills
Despite the skepticism among members of the orthopedic surgery department at the implementation of the program, Mears noted they found a decrease in the number of opioid pills and number of morphine-milligram equivalents prescribed across all procedures, as well as a decrease in the number of refills.
“I think [reducing refills is] how we can make a big impact on [the opioid epidemic],” Mears said. “There is a certain percentage of patients who have elective orthopedic surgery [and] have a permanent problem with opioids and if we can reduce or avoid that, we are making a huge societal gain.”
Mears believes they could further reduce the number of tablets they prescribe and that identification of patients who need fewer opioids after surgery may help with that reduction.
“I think there are some patients who have less pain, who just tolerate pain well or do well and need few narcotic tablets and who you could give a smaller amount, and then the tablets are not out there for general consumption,” Mears said. “They have not been prescribed at all, which is a good thing.” – by Casey Tingle
Disclosure: Mears reports no relevant financial disclosures.