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- Title
Prescription of opioids to post-operative orthopaedic patients at time of discharge from hospital: a prospective observational study.
- Authors
Ho, Edward; Doherty, Matthew; Thomas, Robert; Attia, John; Oldmeadow, Christopher; Clapham, Matthew
- Abstract
Background and aims: Excessive opioid prescribing can lead to adverse consequences including stockpiling, misuse, dependency, diversion and mortality. Increased prescriptions to post-operative inpatients as part of their discharge planning may be a significant contributor. Primary aims included comparing the amount of opioids prescribed, consumed, left unused and their relationship with pain and functionality. Methods: A total of 132 consecutive patients who underwent elective orthopaedic surgery were prospectively audited. Daily oral morphine equivalent (DME) of opioids prescribed was compared with opioids consumed and amount left unused 7-10 days after discharge. For analysis, patients were split into three groups: total knee replacement (TKR), hand surgery (Hands), and miscellaneous (Misc). Results: The mean dose of opioid prescribed per patient was 108.5 mg DME. TKR consumed 33-35% more opioids than Misc (p = 0.0283) and Hands (p = 0.0975). Age was a significant independent factor for opioid consumption in the 50th and 75th percentiles of Hands (p = 0.05). An average of 36 mg DME per patient was left unused with Hands having the highest median DME (37 mg) unused. In the total cohort, 26% of patients were discharged with more DME than their last 24 h as an inpatient and had at least 50% of their tablets left unused at follow-up. Conclusions: Over-prescription of opioids occurs at discharge which can increase the risk of harm. New intervention is needed to optimise prescribing practises. Implications: Changes to prescribing habits and workplace culture are required to minimise unnecessary opioid prescribing but will be challenging to implement. A multilayered approach of electronic prescribing, opioid stewardship and targeted educational awareness programmes is recommended.
- Publication
Scandinavian Journal of Pain, 2018, Vol 18, Issue 2, p253
- ISSN
1877-8860
- Publication type
Article
- DOI
10.1515/sjpain-2017-0149