Postoperative Analgesia Protocol: A Resident‐Led Effort to Standardize Opioid Prescribing Patterns

• Published in: The Laryngoscope 2021-05, Vol.131 (5), p.982-988
• Main Authors: Meyer, Charles, Winters, Jessica, Brady, Rebecca G., Riddick, Jeanelle B., Folsom, Craig, Jardine, Dinchen
• Format: Article
• Language: English
• Subjects: Academic Medical Centers - organization & administration; Academic Medical Centers - standards; Adult; Analgesics, Opioid - therapeutic use; Clinical Protocols - standards; Drug Prescriptions - standards; Drug Prescriptions - statistics & numerical data; Humans; Internship and Residency - organization & administration; Internship and Residency - standards; Internship and Residency - statistics & numerical data; Laryngoscopy; Morphine; Narcotics; Opioid Epidemic - prevention & control; opioid management; Opioid-Related Disorders - epidemiology; Opioid-Related Disorders - etiology; Opioid-Related Disorders - prevention & control; otolaryngology; Otorhinolaryngologic Surgical Procedures - adverse effects; Pain Management - methods; Pain Management - standards; Pain Measurement; Pain, Postoperative - diagnosis; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Practice Patterns, Physicians' - organization & administration; Practice Patterns, Physicians' - statistics & numerical data; Program Evaluation; Quality control; quality improvement; Retrospective Studies; standardization; Surgeons - standards; Surgeons - statistics & numerical data; Surgery; Tertiary Care Centers - organization & administration; Tertiary Care Centers - standards; Tertiary Care Centers - statistics & numerical data; Thyroid gland; United States - epidemiology
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.29087

Objectives The combined impact of variable surgeon prescribing preferences and low resident prescribing comfort level can lead to significant disparity in opioid prescribing patterns for the same surgery in the same academic surgical practice. We report the results of a resident led initiative to standardize postoperative prescription practices within the Department of Otolaryngology at a single tertiary‐care academic hospital in order to reduce overall opioid distribution. Study Design Retrospective cohort study. Methods Following approval by the Institutional Review Board, performed a retrospective review of 12 months before (July 2016–June 2017) and after (July 2017–June 2018) implementation of the Postoperative Analgesia Protocol, which included all adults undergoing tonsillectomy, septoplasty, thyroidectomy, parathyroidectomy, tympanoplasty, middle ear exploration, stapedectomy, and ossicular chain reconstruction. Results Seven hundred and thirty eight procedures met inclusion criteria. Following implementation, total morphine milligram equivalents decreased by 26% (P