• J. Am. Coll. Surg. · Nov 2024

    Implementation of Electronic Medical Record Interventions to Maximize Opioid Disposal after Surgery in Routine Clinical Practice.

    • Yash Deshmukh, Mateo L Amezcua, Brendan W Barth, Robin R Cotter, and Richard J Barth.
    • Dartmouth Geisel School of Medicine, Hanover, NH.
    • J. Am. Coll. Surg. 2024 Nov 22.

    BackgroundDespite guideline directed opioid prescribing after surgery, many patients retain excess opioids. Leftover pills increase the risk for misuse, diversion, and dependency. It is unclear whether interventions applied in routine clinical practice can increase excess opioid disposal rates.Study DesignAll adult patients at our institution with postoperative opioid prescriptions were identified in general surgery, otolaryngology, plastic surgery, neurosurgery, urology and transplant surgery. Disposal rates for 453 pre-intervention patients (surgery between 3/1/23-6/30/23) were compared with 545 intervention patients (surgery between 10/1/23-1/31/24). Pre- and post-intervention patients were called 1-3 months after surgery and asked about excess opioids.Interventions:1. Opioid disposal information sheets provided after surgery.2. Opioid disposal reminder delivered via patient portal in electronic medical record (EMR).3. Best practice alert (BPA) triggered in EMR at post operative visit reminded providers to discuss opioid disposal.ResultsOpioid disposal outcomes were obtained from 70% (699/998) of patients. 54% (375/699) had excess opioids. The percentage of patients disposing of their excess opioids increased from 30% (39/130) pre-intervention to 83% (204/245) post-intervention, p<0.00001. Forty-seven percent (247/545) of post-intervention patients had discussions with their providers after a BPA fired at their post-operative visits. Patients who had a provider discussion were more likely to dispose of excess opioids than those who only received an information sheet and patient portal reminder (92% vs 70%, p < 0.00001).ConclusionsInterventions easily incorporated into the EMR as part of routine clinical practice can markedly increase excess opioid disposal rates after surgery. When information on opioid disposal and patient portal reminders are combined with disposal discussions with providers at the postoperative visit, opioid disposal rates of >90% can be achieved.Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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