scholarly journals Impact of Policy Interventions on Postoperative Opioid Prescribing

Pain Medicine ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 1212-1218 ◽  
Author(s):  
Charles D MacLean ◽  
Mayo Fujii ◽  
Thomas P Ahern ◽  
Peter Holoch ◽  
Ruby Russell ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Baseline Period ◽  
Policy Implications ◽  
Standards Of Care ◽  
Surgical Specialty ◽  
Organizational Policies ◽  
Opioid Prescribing ◽  
Policy Interventions ◽  
Observational Study Design

Abstract Objective To assess postoperative opioid prescribing in response to state and organizational policy changes. Methods We used an observational study design at an academic medical center in the Northeast United States over a time during which there were two important influences: 1) implementation of state rules regarding opioid prescribing and 2) changes in organization policies reflecting evolving standards of care. Results were summarized at the surgical specialty and procedure level and compared between baseline (July–December 2016) and postrule (July–December 2017) periods. Results We analyzed data from 17,937 procedures from July 2016 to December 2017, two-thirds of which were outpatient. Schedule II opioids were prescribed in 61% of cases and no opioids at all in 28%. The median morphine milligram equivalent (MME) prescribed at discharge decreased 40%, from 113 MME in the baseline period to 68 MME in the postrule period. Decreases were seen across all the surgical specialties. Conclusions Postoperative opioid prescribing at the time of hospital discharge decreased between 2016 and 2017 in the setting of targeted and replicable state and health care organizational policies. Policy Implications Policies governing the use of opioids are an effective and adoptable approach to reducing opioid prescribing following surgery.

Evaluating the Impact of Auto-Calculation Settings on Opioid Prescribing at an Academic Medical Center

2019 ◽  
Vol 45 (6) ◽  
pp. 416-422
Author(s):  
Garrett Crothers ◽  
David A. Edwards ◽  
Jesse M. Ehrenfeld ◽  
Edward Woo ◽  
Lauren McCluggage ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Opioid Prescribing ◽  
Academic Medical ◽  
The Impact

scholarly journals Impact of a Central-Line Insertion Site Assessment (CLISA) score on localized insertion site infection to prevent central-line–associated bloodstream infection (CLABSI)

2019 ◽  
Vol 41 (1) ◽  
pp. 59-66 ◽  
Author(s):  
Shruti K. Gohil ◽  
Jennifer Yim ◽  
Kathleen Quan ◽  
Maurice Espinoza ◽  
Deborah J. Thompson ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Insertion Site ◽  
Baseline Period ◽  
Central Line ◽  
Lower Percentage ◽  
Site Assessment ◽  
Central Line Insertion ◽  
Line Insertion ◽  
The Impact

AbstractObjective:To assess the impact of a newly developed Central-Line Insertion Site Assessment (CLISA) score on the incidence of local inflammation or infection for CLABSI prevention.Design:A pre- and postintervention, quasi-experimental quality improvement study.Setting and participants:Adult inpatients with central venous catheters (CVCs) hospitalized in an intensive care unit or oncology ward at a large academic medical center.Methods:We evaluated CLISA score impact on insertion site inflammation and infection (CLISA score of 2 or 3) incidence in the baseline period (June 2014–January 2015) and the intervention period (April 2015–October 2017) using interrupted times series and generalized linear mixed-effects multivariable analyses. These were run separately for days-to-line removal from identification of a CLISA score of 2 or 3. CLISA score interrater reliability and photo quiz results were evaluated.Results:Among 6,957 CVCs assessed 40,846 times, percentage of lines with CLISA score of 2 or 3 in the baseline and intervention periods decreased by 78.2% (from 22.0% to 4.7%), with a significant immediate decrease in the time-series analysis (P < .001). According to the multivariable regression, the intervention was associated with lower percentage of lines with a CLISA score of 2 or 3, after adjusting for age, gender, CVC body location, and hospital unit (odds ratio, 0.15; 95% confidence interval, 0.06–0.34; P < .001). According to the multivariate regression, days to removal of lines with CLISA score of 2 or 3 was 3.19 days faster after the intervention (P < .001). Also, line dwell time decreased 37.1% from a mean of 14 days (standard deviation [SD], 10.6) to 8.8 days (SD, 9.0) (P < .001). Device utilization ratios decreased 9% from 0.64 (SD, 0.08) to 0.58 (SD, 0.06) (P = .039).Conclusions:The CLISA score creates a common language for assessing line infection risk and successfully promotes high compliance with best practices in timely line removal.

An Evaluation of Opioid Prescribing Preferences in Surgical Residents and Faculty at a Large Academic Medical Center

2020 ◽  
Vol 231 (4) ◽  
pp. S240
Author(s):  
Victoria Huynh ◽  
Kathryn Colborn ◽  
Kristin Emilia Rojas ◽  
Nicole Townsend ◽  
Gretchen M. Ahrendt ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Opioid Prescribing ◽  
Surgical Residents ◽  
Academic Medical

scholarly journals The Impact Of Academic Medical Center Policies Restricting Direct-To-Physician Marketing On Opioid Prescribing

2020 ◽  
Vol 39 (6) ◽  
pp. 1002-1010 ◽  
Author(s):  
Matthew D. Eisenberg ◽  
Elizabeth M. Stone ◽  
Harlan Pittell ◽  
Emma E. McGinty
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Opioid Prescribing ◽  
Academic Medical ◽  
The Impact

Service Value Activities by Nurse Practitioners in Ambulatory Specialty Care

2020 ◽  
Vol 21 (2) ◽  
pp. 95-104 ◽  
Author(s):  
Shira G. Winter ◽  
Karen Duderstadt ◽  
Garrett K. Chan ◽  
Joanne Spetz ◽  
Linda M. Stephan ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Nurse Practitioners ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Quality ◽  
Specialty Care ◽  
Direct Patient Care ◽  
Surgical Specialty ◽  
Service Value

The increase in nurse practitioners (NPs) in ambulatory medical and surgical specialty settings has prompted inquiry into their role and contribution to patient care. We explored the role and contribution of NPs in ambulatory specialty care through their activities outside of direct care and billable visits (referred to as service value activities), and how NPs perceive these activities enhance quality and efficiency of care, for both patients and the health care institution. This qualitative thematic analysis examined interviews from 16 NPs at a large academic medical center about their role and contribution to patient care quality and departmental efficiency beyond billable visits. Five categories of NP contribution were identified: promoting patient care continuity, promoting departmental continuity, promoting institutional historical and insider knowledge, addressing time-sensitive issues, and participating in leadership and quality improvement activities. As the role of NPs in specialty care grows and health care systems emphasize quality of care, it is appropriate to explore the quality- and efficiency-enhancing activities NPs perform in specialty care beyond direct patient care.

scholarly journals Postoperative opioid prescribing patterns and use after vascular surgery

2018 ◽  
Vol 24 (1) ◽  
pp. 63-69 ◽  
Author(s):  
Ilsley B Colton ◽  
Mayo H Fujii ◽  
Thomas P Ahern ◽  
Charles D MacLean ◽  
Julie E Lahiri ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Best Practice ◽  
Medical Center ◽  
Academic Medical Center ◽  
Prescribing Patterns ◽  
Opioid Use ◽  
Patient Centered ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Prescribing Practice

The aim of this study was to assess postoperative opioid prescribing patterns, usage, and pain control after common vascular surgery procedures in order to develop patient centered best-practice guidelines. We performed a prospective review of opioid prescribing after seven common vascular surgeries at a rural, academic medical center from December 2016 to July 2017. A standardized telephone questionnaire was prospectively administered to patients ( n = 110) about opioid use and pain management perceptions. For comparison we retrospectively assessed opioid prescribing patterns ( n = 939) from July 2014 to June 2016 normalized into morphine milligram equivalents (MME). Prescribers were surveyed regarding opioid prescription attitudes, perceptions, and practices. Opioids were prescribed for 78% of procedures, and 70% of patients reported using opioid analgesia. In the prospective group, the median MMEs prescribed were: VEIN (31, n = 16), CEA (40, n = 14), DIAL (60, n = 17), EVAR (108, n = 8), INFRA (160, n = 16), FEM TEA (200, n = 11), and OA (273, n = 4). The median proportion of opioids used by patients across all procedures was only 30% of the amount prescribed across all procedures (range 14–64%). Patients rated the opioid prescribed as appropriate (59%), insufficient (16%), and overprescribed (25%), and pain as very well controlled (47%), well controlled (47%), poorly controlled (4%), and very poorly controlled (2%). In conclusion, we observed significant variability in opioid prescribing after vascular procedures. The overall opioid use was substantially lower than the amount prescribed. These data enabled us to develop guidelines for opioid prescribing practice for our patients.

Gaps in the Postoperative Conversation: A Comprehensive Review of Current Practices and the Unmet Needs of Surgeons, Families, and Waiting Room Personnel

2017 ◽  
Vol 83 (7) ◽  
pp. 812-820 ◽  
Author(s):  
Brandon Singletary ◽  
Nisha Patel ◽  
Andrew Mims ◽  
Andrew Smedley ◽  
Jacob Swords ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Standard Of Care ◽  
Nominal Group ◽  
Contact Method ◽  
Surgical Specialty ◽  
Waiting Room ◽  
Nominal Groups ◽  
Barriers And Opportunities ◽  
Critical Components

Perioperative communication between surgeons and caregivers is an important aspect of patient care, with postoperative conversations (POCs) being critical. Literature suggests current communication practices may be suboptimal. Identifying barriers and opportunities could improve patient and caregiver satisfaction and increase surgeon efficiency. This mixed method study included 1) prospective study of all patients undergoing a surgery at an academic medical center between September 2014 and March 2016 and 2) nominal groups of physicians, caregivers, and waiting room personnel (WRP). Nominal groups ranked standard of care themes needing intervention. Multivariate logistic regression estimated the association of surgeon and procedure characteristics with POC practices considering both location and contact method. Data on 15,820 operations showed that surgical specialty (P ≤ 0.0001), inpatient status (P ≤ 0.0001), planned discharge destination (P = 0.0003), patient race (P = 0.02), and caregiver relationship (P ≤ 0.0001) were all significantly associated with receiving a private POC. Nominal group results provided opportunities for improvement: regular updates (caregivers), locating the caregivers postoperation (surgeons), clear communication between caregivers and surgeons (WRP). This study examines the perioperative communication. Surgeons, caregivers, and WRP identified effective communication as a top intervention priority. Managing caregiver expectations, addressing concerns of WRP, and creating an efficient environment for surgeons appear to be critical components to communication.

Reducing the Pain Behind Opioid Prescribing in Primary Care

Pain Medicine ◽  
2020 ◽  
Vol 21 (7) ◽  
pp. 1377-1384
Author(s):  
José Luis González ◽  
Radhika Prabhakar ◽  
Jennifer Marks ◽  
Cheryl L P Vigen ◽  
Jagruti Shukla ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Clinic ◽  
High Dose ◽  
Care Clinic ◽  
Opioid Prescribing ◽  
Number Of Patients ◽  
Primary Care Resident

Abstract Objective To describe the efficacy of a comprehensive approach aimed at reducing opioid prescribing in an internal medicine resident clinic. Design Retrospective observational study. Setting Internal medicine primary care resident clinic at a large urban academic medical center. Subjects All patients receiving opioid prescriptions from the primary care clinic. Methods We reviewed pharmacy dispensing data for two hospital-affiliated pharmacies for resident primary care patients filling opioid prescriptions between July 2016 and July 2018. We instituted a comprehensive set of interventions that included resident education, limiting supervision of encounters for long-term opioid therapy (LTOT) to a fixed set of faculty champions, and providing alternate modalities for pain control. We calculated the change in number of opioid prescriptions dispensed, number of patients receiving opioid prescriptions, morphine milligram equivalents (MMEs) dispensed, and average per-patient daily MMEs dispensed. Results We observed an average monthly reduction of 2.44% (P &lt; 0.001) in the number of prescriptions dispensed and a 1.83% (P &lt; 0.001) monthly reduction in the number of patients receiving prescriptions. Over the two-year period, there was a 74.3% reduction in total MMEs prescribed and a 66.5% reduction in the average MMEs prescribed per patient. Conclusions Our findings demonstrate a significant reduction in opioid prescribing after implementation of a comprehensive initiative. Although our study was observational in nature, we witnessed a nearly threefold decrease in opioid prescribing compared with national trends. Our results offer important insights for other primary care resident clinics hoping to engender safe prescribing practices and curb high-dose opioid prescribing.

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