Opioid information pamphlet increases postoperative opioid disposal rates: a before versus after quality improvement study (pdf)

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Opioid information pamphlet increases postoperative opioid disposal rates: a before versus after quality improvement study

Can J Anesth/J Can Anesth (2016) 63:31–37 DOI 10.1007/s12630-015-0502-0 REPORTS OF ORIGINAL INVESTIGATIONS Opioid information pamphlet increases postoperative opioid disposal rates: a before versus after quality improvement study Un dépliant d’information sur les opioı̈des augmente leur taux d’élimination postopératoire: une étude avant et après d’amélioration de la qualité Peter Rose, MD . Jenni Sakai, RN . Ruth Argue, BA . Kevin Froehlich, MD . Raymond Tang, MD Received: 28 May 2015 / Revised: 3 August 2015 / Accepted: 21 September 2015 / Published online: 2 October 2015 Ó Canadian Anesthesiologists’ Society 2015 Abstract Purpose Half of postoperative patients are prescribed an opioid, but a majority do not store or dispose of them properly thus risking diversion. We examined the efficacy of an opioid educational pamphlet addressing opioid weaning, storage, and disposal. We hypothesized that the pamphlet would increase the rate of proper opioid disposal, storage, and weaning. Methods This prospective before and after study was conducted at UBC Hospital in primary total hip or knee arthroplasty patients. Adults with American Society of Anesthesiologists physical class I-III, with no addiction history and consuming B 30 mg of morphine equivalents daily were enrolled in the study. Two groups received similar standard management, except the intervention group additionally received the opioid education Author contributions Peter Rose, Jenni Sakai, Ruth Argue, Kevin Froehlich, and Raymond Tang were involved in the study design. Peter Rose, Jenni Sakai, and Ruth Argue were involved in data acquisition. Peter Rose, Kevin Froehlich, and Raymond Tang were involved in data analysis and manuscript preparation. Jenni Sakai and Ruth Argue were involved in manuscript revision. Electronic supplementary material The online version of this article (doi:10.1007/s12630-015-0502-0) contains supplementary material, which is available to authorized users. P. Rose, MD J. Sakai, RN R. Argue, BA K. Froehlich, MD R. Tang, MD Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada R. Tang, MD (&) Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Rm 3300, 910 W 10th Ave, Vancouver, BC V5Z 1M9, Canada e-mail: pamphlet. Patients were contacted four weeks postoperatively to complete a survey. The primary endpoint was to evaluate proper opioid disposal rates. Secondary endpoints were to evaluate opioid storage and weaning rates. Results Two hundred twenty-six patients were enrolled and 172 (76%) completed the survey. Among patients who had discontinued opioids, rates of proper disposal increased from 2/42 (5%) to 12/45 (27%) in those receiving the pamphlet (difference in proportions, 22%; 95% confidence interval (CI), 5 to 38; P = 0.005). Secure opioid storage did not improve in those receiving the opioid pamphlet [before, 18/86 (21%) vs after, 20/86 (23%); difference in proportions, 3%; 95% CI, -11 to 15; P = 0.713]. The proportion of patients weaned from opioids was unchanged by the pamphlet [before, 42/86 (49%) vs after, 45/86 (52%); P = 0.735]. Conclusion The introduction of an education pamphlet significantly improved self-reported proper opioid disposal rates in postoperative patients. Résumé Objectif Un opioı̈de est prescrit en postopératoire à près de la moitié des patients, mais la majorité d’entre eux ne les conserve pas ni ne les élimine de façon appropriée, ce qui expose au risque de détournement des médicaments. Nous avons examiné l’efficacité d’un dépliant éducatif sur les opioı̈des, leur sevrage, conservation et élimination. Nous avons émis l’hypothèse que le dépliant augmenterait les taux de pratique adéquate d’élimination, conservation et sevrage aux opioı̈des. Méthodes Cette étude prospective avant et après a été menée à l’hôpital UBC avec des patients ayant subi une arthroplastie de première intention de hanche ou de genou. 123 32 Des patients classés I à III selon la classification physique de l’American Society of Anesthesiologists, sans antécédents de dépendance et consommant B 30 mg/jour d’équivalents morphine ont été inclus dans l’étude. La prise en charge des deux groupes a été similaire si ce n’est que le groupe interventionnel a reçu en plus le dépliant éducatif sur les opioı̈des. Les patients ont été contactés quatre semaines après l’opération pour répondre à l’enquête. Le critère d’évaluation principal était l’évaluation du taux d’élimination appropriée des opioı̈des. Les critères d’évaluation secondaires étaient l’évaluation des taux de conservation et de sevrage des opioı̈des. Résultats Deux cent vingt-six patients ont été recrutés et 172 (76 %) ont complété l’enquête. Parmi les patients ayant interrompu les opioı̈des, le taux d’élimination correcte est passé de 2/42 (5 %) à 12/45 (27 %) pour ceux qui avaient reçu le dépliant (différence de 22 %; intervalle de confiance à 95 % [IC], 5 à 38; P = 0,005). La conservation sécuritaire des opioı̈des n’a pas été améliorée chez ceux qui avaient reçu le dépliant (avant, 18/86 [21 %] contre après, 20/86 [23 %]); différence de 3 %; IC à 95 %, -11 à 15; P = 0,713). Le pourcentage de patients sevrés de morphiniques n’a pas été modifié par le dépliant (avant, 42/86 [49 %] contre après, 45/86 [52 %]); P = 0,735). Conclusion L’introduction d’un dépliant éducatif a significativement amélioré le taux d’élimination autorapporté des opioı̈des chez les patients en postopératoire. Prescription opioid use in Canada has tripled in the last decade, and Canada is the second largest consumer of opioids per capita in the world.1,2 Approximately 20% of Canadians have been prescribed an opioid in the past year, and another 5% admit to using opioid medications that were not prescribed for them.2 The rates of addiction, overdose, and death attributed to opioids doubled from 13.7 per million in 1991 to 27.2 per million in 2004.3 Unfortunately, non-medical prescription opioid use accounts for 40% of these overdoses.2 Opioids are an accepted important therapy in the management of post-surgical pain. Half of all surgical patients are discharged with opioid prescriptions, and 3-5% continue these medications beyond the expected duration of postoperative pain.4,5 Up to 3% of patients undergoing major lower limb joint arthroplasty remained on opioids 58 months postoperatively.5 Although it is important to treat postoperative pain, the long-term use of opioids can be deleterious, with a reduced quality of life and an increase in morbidity, including an increase in cardiac events.6-8 123 P. Rose et al. Substantial portions of prescribed opioid medications go unused, and many patients do not dispose of them properly, risking diversion into the community.9,10 In fact, in some postoperative data, only 1% of patients appropriately ret (...truncated)