Safe opioid prescribing: a community-based approach

Background To compare opioid prescribing practices of resident physicians across a variety of surgical and nonsurgical specialties; to identify factors which influence prescribing practices; and to examine resident utilization of best practice supplemental resources. Methods An anonymous survey which assessed prescribing practices was completed by residents from one of several different subspecialties, including internal medicine, obstetrics and gynecology, general surgery, neurosurgery, orthopedic surgery, and urology. Fisher’s exact test assessed differences in prescribing practices between specialties. Results Only 35% of residents reported receiving formal training in safe opioid prescribing. Overall, the most frequently reported influences on prescribing practices were the use of standardized order sets for specific procedures, attending preference, and patient’s history of prescribed opioids. Resident physicians significantly underutilize best practice supplemental resources, such as counseling patients on pain expectations prior to prescribing opioid medication; contacting established pain specialists; screening patients for opioid abuse; referring to the Prescription Monitoring Program; and counseling patients on safe disposal of unused pills ( P < .001). Discussion The incorporation of comprehensive prescribing education into resident training and the utilization of standardized order sets can promote safe opioid prescribing.

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Why we still prescribe so many opioids: A qualitative study on barriers and facilitators to prescribing guideline implementation

Journal of Opioid Management ◽

10.5055/jom.2021.0622 ◽

2021 ◽

Vol 17 (2) ◽

pp. 115-124

Author(s):

Kathryn W. Zavaleta, MHSA ◽

Lindsey M. Philpot, PhD, MPH ◽

Julie L. Cunningham, PharmD, RPh ◽

Halena M. Gazelka, MD ◽

Holly L. Geyer, MD ◽

...

Keyword(s):

Best Practice ◽

Guideline Implementation ◽

Healthcare Setting ◽

Medical Specialty ◽

Critical Systems ◽

Healthcare Organizations ◽

Opioid Prescribing ◽

Daunting Challenge ◽

Additional Education ◽

Safe Opioid Prescribing

Introduction: Opioid prescribing occurs within almost every healthcare setting. Implementation of safe, effective opioid stewardship programs represents a critical but daunting challenge for medical leaders. This study sought to understand the barriers and aids to the routine use of clinical guidelines for opioid prescribing among healthcare professionals and to identify areas in need of additional education for prescribing providers, pharmacists, and nurses.Methods: Data collection and analysis in 2018-2019 employed a team of two trained facilitators who conducted 20 focus groups using a structured facilitation guide to explore operational, interpersonal, and patient care-related barriers to best practice adherence. Each professional group was interviewed separately, with similar care settings assigned together. Invitation to participate was based on a sampling methodology representing emergency, medical specialty, primary care, and surgical practice settings.Results: Key concerns among all groups reflected the inadequacy of available tools for staff to appropriately assess and treat patients’ pain. Tools and technology to support safe opioid prescribing were also cited as a barrier by all three professional groups. All groups noted that prescribers tend to rely upon default settings within the electronic medical record when issuing prescriptions. Both pharmacists and prescribers cited time and scheduling as a barrier to adherence.Conclusions: In spite of significant regulatory and public policy efforts to address the opioid crisis, healthcare organizations face significant challenges to improve adherence to best practice prescribing guidelines. These findings highlight several facilitators for change which could boost opioid stewardship initiatives to focus on critical systems’ factors for improvement.

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Improving Residents' Safe Opioid Prescribing for Chronic Pain Using an Objective Structured Clinical Examination

Journal of Graduate Medical Education ◽

10.4300/jgme-d-15-00273.1 ◽

2016 ◽

Vol 8 (3) ◽

pp. 390-397 ◽

Cited By ~ 15

Author(s):

Daniel P. Alford ◽

Brittany L. Carney ◽

Belle Brett ◽

Sharon J. Parish ◽

Angela H. Jackson

Keyword(s):

Internal Medicine ◽

Chronic Pain ◽

Clinical Examination ◽

Academic Medical Center ◽

Objective Structured Clinical Examination ◽

Opioid Prescribing ◽

Internal Medicine Residents ◽

Number Of Patients ◽

Safe Opioid Prescribing ◽

And Control

ABSTRACT Internal medicine residents care for a sizable number of patients with chronic pain. Programs need educational strategies to promote safe opioid prescribing.Background To describe a safe opioid prescribing education program utilizing an objective structured clinical examination (OSCE) and report the resulting impact on residents' knowledge, confidence, and self-reported practices.Objective Using a quasi-experimental design, 39 internal medicine residents from an urban academic medical center were assigned to 1 of 4 groups: 1-hour lecture only, lecture followed by immediate OSCE, lecture followed by 4-month delayed OSCE, and control. Safe opioid prescribing knowledge, confidence, and self-reported practices were assessed at baseline and at 8 months.Methods At 8 months, knowledge, confidence, and self-reported practices improved in the control and in all 3 intervention groups. The immediate OSCE group had the greatest improvements in combined confidence scores within group (0.74, P = .01) compared to controls (0.52, P = .05), using a 5-point scale. This group also had the greatest improvement in self-reported practice changes (1.04, P = .04), while other groups showed nonsignificant improvements—delayed OSCE (0.43, P = .44), lecture only (0.66, P = .24), and control (0.43, P = .19).Results Safe opioid prescribing education that includes a lecture immediately followed by an OSCE had an impact on residents' confidence and self-reported practices greater than those for delayed OSCE or lecture only groups. There was no difference in knowledge improvement among the groups. Lecture followed by an OSCE was highly regarded by residents, but required additional resources.Conclusions

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