A Team-based Approach to Safe Opioid Prescribing for Surgical Patients

The University of Chicago brought together surgery trainees, advanced practice providers, and surgical nurses in an attempt to make opioid prescribing and administration safer.

Project leaders educated practitioners on safe opioid practices for surgical patients; participants included 26 surgical trainees, eight advanced practice providers and 97 surgical nurses. Training involved including a morphine equivalent daily dosing calculator in the electronic medical record that enabled the clinical team to determine an appropriate dose. Participants’ perceptions, current practices and knowledge were measured using a pre- and post-intervention survey (SQUIRE checklist). The objective was to provide opioid education and training to improve safe opioid prescribing practices in a group of surgical patients.

“Reducing inappropriate use of opioids aligns with Choosing Wisely’s mission of reducing patient harm,” said Alaine Kamm, DNP, Department of Surgery, University of Chicago.

Results indicated:

• Positive clinical change in perception of opioid use in surgical patients following the intervention and a modest decrease in the average morphine equivalent daily dosing at discharge in general and transplant surgery patients.
• Modest decrease in the average morphine equivalent daily dosing at discharge in general and transplant surgery patients.
• Perception of the number of opioid medications needed at discharge decreased across all scenarios after the education and training.

The project leaders concluded that effective pain management for surgical patients must be individualized and determined though an interdisciplinary approach. They recommend making training tools and opioid calculators in the electronic medical record easily accessible. Continuing education for clinicians is essential to ensure surgical patient safety.

“The project took place during a nursing work force disruption which made participation challenging,” Kamm said. “It ended in the midst of a global pandemic involving the cancellation of all elective surgeries at the hospital, which led to an earlier than anticipated end to the project work. We had great team work and support despite the challenges. While the project has concluded, there is discussion about incorporating the opioid education in the intern boot camp training in the summer of 2021.”

Interested readers can learn more about the project here.