Opioid prescribing preferences and practices of surgical residents and faculty differ


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Opioid prescribing preferences and practices among surgical residents and faculty differ, according to new study published in the journal Surgery.

The study, titled “Assessing Opioid Prescribing Preferences Among Surgical Residents and Faculty,” was based on a survey of 56 residents and 57 professors in the Department of Surgery at the University’s Faculty of Medicine. from Colorado. In the survey, participants were asked how many oxycodone tablets they would prescribe for 14 common surgeries.

Responses were compared between residents and faculty, as well as with the Opioid Prescribing Engagement Network (OPEN) guidelines and actually prescribed opioids (from electronic medical records).

The opioid epidemic is a huge problem. We know that over two-thirds of the prescriptions that surgeons prescribe are not used in the immediate postoperative period by patients and that one in 16 patients who are prescribed opioids for surgery end up having chronic use. of opioids.. “

Sarah Tevis, MD, study principal investigator and assistant professor of surgery in surgical breast oncology, Anschutz Medical Campus at the University of Colorado

“It is very well established that postoperative opioid prescribing varies from cover to cover,” continues Victoria Huynh, MD, third year resident in the department and first author of the study. “We wanted to see how we’re doing as a service in terms of prescribing opioids.”

Comparison of Resident and Faculty Opioid Prescribing Habits

The results showed that professors preferred to prescribe more opioid tablets than suggested by OPEN in five of the 14 surgeries, while residents did so in nine of the procedures.

“In some cases, faculty and residents have prescribed more than suggested for some surgeries. So this is definitely an opportunity for improvement,” Huynh said. “But I think the most striking aspect of the study was how the prescribing preferences of faculty and residents differ from each other.”

Tevis said one of the reasons vendors may prescribe more than what the OPEN guidelines suggest is CU’s large catchment area.

“We have patients who come in several hours and other conditions for surgery. So one factor may be that prescribers are concerned that patients will drive eight hours home and not have enough power. pain medication, ”says Tevis.

Another concern is patient satisfaction. Tevis says providers may fear that a patient who runs out of pain medication will be less satisfied with their care or need to call back or even go to the emergency room for more pain medication.

As to why residents seem to prefer prescribing more opioids than professors, Huynh believes that may be at least in part due to the limited interaction residents have with patients after surgery.

“We often see patients before and immediately after the operation, and we help take care of them in the immediate postoperative period while they are in the hospital,” Huynh explains. “But when it comes to postoperative follow-up care, we are not as involved as the assistants.”

Tevis agrees. “When I call patients with their pathology results about a week after surgery, I also ask them about their pain control. But residents miss a lot of those comments.”

The study also assessed how often faculty communicate their prescribing preferences to residents and the desire of all participants for feedback and transparency in prescribing practices.

Residents (80%) and faculty (75%) were open to seeing regular reports on personal opioid prescribing practices, and most were also open to seeing how their numbers compared to that of their peers.

Education and Assessment: Initiatives to Address Postoperative Opioid Overprescribing

Since studies show that most prescription opioid addicts receive drugs from family and friends, the challenge is to learn how to adequately treat postoperative pain while limiting the possibilities for abuse and diversion.

“For us, that means limiting the excessive opioids that we prescribe,” says Huynh.

As a result of their research, Huynh and some of his co-residents are setting up ongoing initiatives within the surgery department to tackle opioid overprescribing. For example, they developed a dashboard that will allow anyone who prescribes opioids to receive regular feedback on how much they are prescribing and how their prescribing practices compare to their peers. They recently sent it to a handful of professors for feedback on features and functionality.

“We hope that once we get this sorted out, we can send it to the whole department so that everyone can use it,” Huynh said.

Tevis, one of the faculty members who has started using the dashboard, says it’s already proving effective. “Surgeons are competitive people,” she says. “So when we get this email every month, my partners and I immediately start exchanging emails about what we’ve been up to over the last month, how we’re all doing relative to each other. I think people really like those comments, and it influences what they do. “

In addition to the dashboard, Huynh and colleagues have developed pathways (called enhanced recovery protocols after surgery) that providers can follow through a patient’s electronic medical record. The pathways recommend which pain relievers to order before and after surgery, including the number of opioids to prescribe for certain procedures based on national guidelines.

Tevis predicts that the trails will be especially useful for residents who periodically alternate between different services.

“If you haven’t had a breast service in three years, how will you remember how many pills you should order after a lumpectomy? ” she asks. “If it is integrated into this path, it becomes very clear.”

Clinicians have also developed a protocol to use multimodal pain management to try to reduce the need for opioids after surgery, as well as an educational program for residents around opioid prescribing.

“It’s really impressive what Tori has accomplished in just two years in the research lab,” says Tevis. She has looked at this problem from many angles, and her work has already led to great changes in the surgical department. “

Source:

University of Colorado Medical Campus at Anschutz

Journal reference:

Huynh, V., et al. (2021) Assessment of opioid prescribing preferences among surgical residents and faculty. Surgery. doi.org/10.1016/j.surg.2021.02.067.

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