Opioid prescribing improvement in orthopaedic specialty unit in a tertiary hospital: a retrospective audit of hospital discharge data pre‐ and post‐intervention for better opioid prescribing practice

摘要

Background This study aimed to investigate the effects of an intervention focusing on better opioid prescription practice in a tertiary metropolitan hospital orthopaedic unit. Methods Following a previous audit of opioid prescribing in the orthopaedics unit, an intervention comprising the (i) Expert Advisory Group oversight of opioid prescribing, (ii) development of a prescription opioid guideline for various hospital contexts and (iii) a series of education sessions was undertaken to improve opioid prescription practice. A re‐audit was subsequently carried out to determine whether the intervention had had an impact on the previously audited orthopaedic unit. Results Each audit period was 6?months. There were 281 orthopaedic patients in the original audit (1 January 2017–30 June 2017) and 289 in the re‐audit (1 March 2018–31 August 2018). In both audits, a high proportion of patients were discharged to the community on opioids, 82.2% ( n = 231) pre‐intervention and 79.6% ( n = 230) post‐intervention. Statistically significant differences in opioid prescribing were found between audits, including: a reduction in the number of patients discharged on combination opioids from 71.4% to 45.7% ( P ??0.001), a reduction in the provision of full pharmaceutical quantities of opioid on discharge from 29.4% to 6.1% ( P ??0.001) and an increase in opioid weaning plans included in discharge summaries from 6.9% to 87.4% ( P ??0.001). Conclusion Raised awareness across the organization and education for staff more than halved the post‐operative opioid prescription levels. This highlights the capacity for change in hospitals and the ability to work towards safer prescribing of post‐operative opioid therapy.