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J Hand Surg Am. 2015 Feb;40(2):341-6. doi: 10.1016/j.jhsa.2014.10.054. Epub 2014 Dec 24.

The effect of an educational program on opioid prescription patterns in hand surgery: a quality improvement program.

Author information

1
Department of Plastic and Hand Surgery, Institute for Education and Research, Regions Hospital, St. Paul, MN; HealthPartners, Bloomington, MN; Office of Education, University of Minnesota School of Medicine, Minneapolis, MN.
2
Department of Plastic and Hand Surgery, Institute for Education and Research, Regions Hospital, St. Paul, MN; HealthPartners, Bloomington, MN; Office of Education, University of Minnesota School of Medicine, Minneapolis, MN. Electronic address: lkkllnn@aol.com.

Abstract

PURPOSE:

To assess the variability of opioid prescription patterns among hand surgeons in a single practice and to attempt to standardize postoperative prescription sizes based on the patient's surgical procedure.

METHODS:

We performed a preliminary chart review to assess the range of prescription sizes for 4 common hand surgery procedures. A group of hand surgeons agreed to write postoperative opioid prescriptions based on an evaluation of historical prescription patterns. An educational assist device (the pink card) was created to serve as a memory prompt and was given to physicians, midlevel practitioners, and trainees. Subsequent chart reviews of number of pills prescribed were done 3 and 15 months later.

RESULTS:

After implementation of the pink card, the average postoperative prescription size decreased for all 4 case types by 15% to 48%, reaching statistical significance for 2 of the procedures. Variability in prescription sizes decreased in all cases. There was a trend toward a decreasing number of prescription refills over the course of the study. There was no evidence that patients were obtaining refills from other sources within our multigroup practice.

CONCLUSIONS:

Although generalized opioid prescription guidelines exist, they lack specificity. Our multimodal approach using a simple educational-assist device and changes to postoperative order sets significantly affected surgeon behavior without evidence of inadequate treatment of pain.

TYPE OF STUDY/LEVEL OF EVIDENCE:

Therapeutic III.

KEYWORDS:

Attitude of health personnel; education; opioids; physician’s practice patterns; practice guideline

PMID:
25542435
DOI:
10.1016/j.jhsa.2014.10.054
[Indexed for MEDLINE]

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