Excellence in Pharmacy Practice - Interprofessional Collaboration

Development of Standardized Opioid Prescriptions for Post-Laparoscopic Appendectomy and Cholecystectomy Surgeries and Implementation of Patient Information on Safer Opioid Use

Jenny C Chiu and Alice Watt

North York General Hospital,  Toronto, ON

Background: Opioid prescriptions with duration exceeding 7 days for acute pain were associated with double the likelihood of continued use 1 year later. Quantities prescribed vary widely between prescribers. Excess unused opioids are rarely disposed of properly. A 2017 Ontario Student Drug Use Survey showed that 11% of high school students reported non-medical use of opioids and 55% of the time they were obtained from home.

Objectives: The objectives were to standardize discharge opioid prescriptions focusing on laparoscopic appendectomy and cholecystectomy (LA & LC) surgeries and to develop a patient education sheet on opioids.

Methods: A baseline survey was conducted over 3 months in LA/LC patients to establish their opioid usage, pain control, and whether opioid education was received post-operatively. This data was used to develop a standardized prescription. A patient information sheet on proper opioid use, storage and disposal was developed in collaboration with ISMP Canada and support from the Canadian Patient Safety Institute. A post-implementation survey was completed to assess if patients had adequate supply of pain medications and pain control with the new standardized prescription, and to measure rates of opioid education.

Results: Pre-implementation, surgeons prescribed 20 to 30 opioid pills per prescription. The standardized prescription issued 10 tablets.  This led to a 56% decrease in the number of opioids prescribed over the 3-months (from 2672 to 1182 tablets). Results showed that patients were satisfied with their pain control. Patient education on opioids increased from 8.6% to 44%

Conclusions: Implementing a standardized opioid prescription led to a decrease of 1490 opioid tablets prescribed over 3 months. This would amount to around 11,000 less opioid tablets prescribed over 1 year at 1 institution. The opportunity for other surgical programs and institutions to adopt this prescription would mean several thousand less opioids tablets available for diversion.  Increasing patient education may potentially decrease opioid-related misuse.