Implementing an evidence-based guideline to decrease opioids after cardiac surgery.

IF 1.2 4区 医学
Roberto Galao-Malo, Alison Davidson, Rita D'Aoust, Deborah Baker, Mackenzy Scott, Julie Swain
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引用次数: 0

Abstract

Background: Deaths related to overdoses continue growing in the United States. The overprescription of opioids after surgical procedures may contribute to this problem.

Local problem: There is inconsistency in the prescription of opioids in cardiovascular surgery patients. Recommendations regarding the reduction of opioids at discharge are not fully implemented.

Methods: This is a single-center, pre-post quality improvement project in adult patients after elective cardiac surgery through sternotomy.

Interventions: Changes in guidelines, modification of order sets, creation of dashboards, and education to the providers to increase the prescription of acetaminophen around the clock on the step-down unit and at discharge, decrease the number of opioid tablets to 25 or less at discharge and decrease the prescription of opioids to 25 or less morphine milligram equivalents (MME) at discharge.

Results: The preintervention group included 67 consecutive patients who underwent cardiac surgery from November to December 2021. The postintervention group had 67 patients during the same period in 2022. Acetaminophen prescription on the step-down unit increased from 9% to 96% ( p < .001). The proportion of patients discharged with 25 or less opioid tablets increased from 18% to 90% ( p < .001) and with 25 or less MME from 30% to 55% ( p < .01). Acetaminophen prescription at discharge increased from 10% to 48% ( p < .001).

Conclusions: Our intervention increased the use of acetaminophen and decreased the overprescription of opioids in cardiac surgery patients at discharge. Further research is necessary to continue improving pain management to reduce the number of opioids prescribed at discharge.

实施循证指南,减少心脏手术后使用阿片类药物。
背景:在美国,与用药过量有关的死亡人数持续增长。当地问题:心血管手术患者的阿片类药物处方不一致。有关出院时减少阿片类药物用量的建议并未得到充分实施:方法:这是一项单中心、前后质量改进项目,针对的是通过胸骨切开术进行择期心脏手术的成人患者:干预措施:更改指南、修改医嘱集、创建仪表板,并对医疗服务提供者进行教育,以在下级病房和出院时全天候增加对乙酰氨基酚的处方量,将出院时阿片类药物的片剂数量减少到 25 片或更少,并将出院时阿片类药物的处方量减少到 25 或更少吗啡毫克当量(MME):干预前组包括 67 名在 2021 年 11 月至 12 月期间接受心脏手术的连续患者。干预后组包括 2022 年同期的 67 名患者。降级病房的对乙酰氨基酚处方率从 9% 上升至 96%(p < .001)。出院时服用 25 片或 25 片以下阿片类药物的患者比例从 18% 增加到 90%(p < .001),服用 25 片或 25 片以下 MME 的患者比例从 30% 增加到 55%(p < .01)。出院时的对乙酰氨基酚处方从10%增加到48%(P < .001):我们的干预措施增加了对乙酰氨基酚的使用,减少了心脏手术患者出院时阿片类药物的过量处方。有必要开展进一步研究,以继续改善疼痛管理,减少出院时阿片类药物的处方数量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
自引率
16.70%
发文量
172
期刊介绍: The Journal of the American Association of Nurse Practitioners (JAANP) is a monthly peer-reviewed professional journal that serves as the official publication of the American Association of Nurse Practitioners. Published since 1989, the JAANP provides a strong clinical focus with articles related to primary, secondary, and tertiary care, nurse practitioner education, health policy, ethics and ethical issues, and health care delivery. The journal publishes original research, integrative/comprehensive reviews, case studies, a variety of topics in clinical practice, and theory-based articles related to patient and professional education. Although the majority of nurse practitioners function in primary care, there is an increasing focus on the provision of care across all types of systems from acute to long-term care settings.
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