Reducing Overuse of Opioid Prescriptions in Outpatient General Surgery at University of Utah Health
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Transcript of Reducing Overuse of Opioid Prescriptions in Outpatient General Surgery at University of Utah Health
© U N I V E R S I T Y O F U T A H H E A L T H ,
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REDUCING OVERUSE OF OPIOID
PRESCRIPTIONS IN OUTPATIENT
GENERAL SURGERYSURGERY VALUE SYMPOSIUM
BENJAMIN BROOKE, MD, AUSTIN CANNON, MD, ADAM DZUIBA, MD,
LILY GUTNIK, MD, LUKE MARTIN, MD, SEAN STOKES, MD, MARK TAYLOR, MD
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DISCLOSURES
• None
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Defining the Problem
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http://www.cnn.com/2016/09/23/health/heroin-opioid-drug-overdose-deaths-visual-guide/index.html
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”Until clinicians stop prescribing opioids far in
excess of clinical need, this crisis will continue
unabated.”
Califf RM,Woodcock J, Ostroff S. A proactive response to prescription opioid
abuse. New Engl J Med. 2016;374:1480–1485.
Robert Califf, MD
Former Commissioner of the FDA
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AcutePain
OverRx
How much do prescription practices vary at the University of Utah for common general surgery procedures?
Hypothesis: Outpatient general surgery prescription practices vary widely and standardization will reduce cost and narcotic over-prescription without effects on patient satisfaction
OUR QUESTION
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Analysis/Investigation
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WHERE CAN WE MAKE A DIFFERENCE?
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PRESCRIBED
TAKEN
• Partial mastectomy• Partial mastectomy + SLNB• Laparoscopic
cholecystectomy• Laparoscopic Inguinal Hernia
Repair• Open Inguinal Hernia Repair
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• 17,167 tablets prescribed
• 7,360 estimated tablets prescribed (42.8%)
Estimated Need for post-operative General Surgery patientsPartial mastectomy – 5 pillsPartial mastectomy w/ SLNB – 10 pillsLap chole – 15 pills Lap IHR – 15 pillsOpen IHR – 15 pills
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“PORCA” – PAIN ORCA
• Operating Room Cost Accountability (ORCA)
• Pain “ORCA” = PORCA
• Utility that allows tracking of prescribing
practices by practitioner and CPT code
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LAPAROSCOPIC CHOLECYSTECTOMY(7/4/2016-6/29/2017)
Surgeon (de-identified)
Ave
rage
Tab
lets
Rx
Perc
ent
Tota
l Po
pu
lati
on
Tablets Prescribed15 tablets
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ESTIMATED IMPACT – LAP CHOLE
• 421 lap chole cases
• 11, 773 tablets prescribed (avg. 28 tabs/case)
• Using proposed standardized Rx practice
– Reduce to 6,315 tablets prescribed (53.6%)
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Proposed
Intervention
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ORDER SET
• Standardize
prescriptions for the
procedures of
interest
– Lap chole
– IHR – open and lap
– VHR
– Lumpectomy +/-
SLNB
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Impact
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GOING FORWARD
• Patient perception of acute pain management
• Analysis of Rx practice within PORCA
• Post-intervention patient perception
Aug Sept Oct Nov Dec Jan Feb Mar
Pre-intervention Survey
Intervention Data Collection/Analysis
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Perc
ent
Tota
l Po
pu
lati
on
Tablets Prescribed
Overall Goal
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Questions?
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REFERENCES
1. Hill, Maureen V., et al. "Wide variation and excessive dosage of opioid prescriptions for common general
surgical procedures." Annals of surgery 265.4 (2017): 709-714.
2. Wunsch, Hannah, et al. "Opioids prescribed after low-risk surgical procedures in the United States, 2004-
2012." Jama 315.15 (2016): 1654-1657.
3. https://dopl.utah.gov/programs/csdb/
4. Olsen, Yngvild. "The CDC guideline on opioid prescribing: rising to the challenge." Jama 315.15 (2016):
1577-1579.
5. Lillernoe, Keith D. "Annals of Surgery Looks at The Opioid Crisis." Annals of surgery 265.4 (2017).
6. Brummett, Chad M., et al. "New Persistent Opioid Use After Minor and Major Surgical Procedures in US
Adults." JAMA surgery (2017): e170504-e170504.
7. Utah Department of Health Opioid Prescribing Guidelines
8. Hill, Maureen V., et al. "An Educational Intervention Decreases Opioid Prescribing After General Surgical
Operations." Annals of Surgery (2017).
9. http://www.cnn.com/2016/09/23/health/heroin-opioid-drug-overdose-deaths-visual-guide/index.html