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Pre-operative Patient Opioid Education, Standardization Of Prescriptions, And Their Impact On Overall Patient Satisfaction
*Sharbel Elhage, *Otto Thielen, *Andrew Huber, *Javier Otero, *George Monjimbo, *Caleb Suddreth, *Tanushree Prasad, Keith Gersin, *Paul Colavita, *Vedra Augenstein, *B Todd Heniford
Carolinas Medical Center, Charlotte, NC

OBJECTIVE(S):
The opioid epidemic has reached a crisis level in America, and, subsequently, physicians are undergoing significant scrutiny concerning their opioid prescribing patterns, including the lack of consistency. While decreasing opioid prescriptions may positively impact the opioid epidemic, its influence on individual patient satisfaction is inadequately described. The aim of our study was to evaluate the effect of standardized patient education and post-operative opioid regimens on patient satisfaction.

METHODS:
Patients presenting for elective General Surgical procedures were given patient education regarding post-operative pain management including narcotic use and non-narcotic multimodal regimens. Inpatient discharge prescriptions were based on milligrams of oral narcotic required 24hrs prior to discharge: 0mg=10 tablets, 5-15mg=15 tablets, ≥20mg=30 tablets. Patients undergoing all outpatient procedures received 10 pill prescriptions. Patients were then surveyed regarding their pain control after discharge. A goal of 85% patient satisfaction was set. Descriptive data are reported with means and corresponding standard deviations, or percentages.

RESULTS:
In total, 128 patients participated; 46.1% were outpatient procedures. Inpatients' length of stay averaged 4.02.1 days. When patients were asked about pain control satisfaction, 97.7% either agreed or strongly agreed. Similarly, 97.7% agreed/strongly agreed that they received adequate opioid education, and 98.4% stated they received appropriate instruction on which medications to take and when. 93.8% agreed/strongly agreed they received enough pain medication, 5.5% disagreed, and one (0.8%) strongly disagreed. The average pain score on the day after discharge was 5.42.8 out of 10, with the average score decreasing to 4.12.7 on day 4 after discharge. 22.7% of patients took no narcotics after discharge. Only 7 patients (5.5%) required a prescription refill. Of the 10 patients (8%) on narcotics pre-operatively, all agreed/strongly agreed that they were satisfied with their pain control, opioid education, and medication instruction, and 80% believed they received an adequate amount of pain medication.

CONCLUSIONS:
A dedicated, preoperative narcotic/non-narcotic patient education and pain management plan can be highly effective with high patient satisfaction and standardized post-operative narcotic prescribing. The introduction of this practice throughout the hospital will allow uniformity on multiple surgical services for attending surgeons, trainees, nurses, pharmacy, and patients.


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