C. M. Harbaugh2, L. M. Frydrych2, A. B. Coe1, A. N. Thompson1, B. S. Miller2 1University Of Michigan,College Of Pharmacy,Ann Arbor, MI, USA 2University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA
Introduction: Opioids are often prescribed in excess after surgery and patients infrequently dispose of the leftover medication. Excess medications in homes are targets for diversion, placing patients, families and communities at risk for opioid misuse. In this quality improvement study, we explored patient and provider needs to eliminate barriers to opioid disposal.
Methods: Over a 4-month period (3/2018-6/2018) at an academic tertiary referral center, a convenience sample of patients undergoing thyroid and parathyroid surgery were administered a 10-item multiple choice questionnaire about prescription opioid use, receipt of opioid disposal education (ODE), frequency of disposal, and barriers to disposal at the 2-week postoperative visit. Providers at multiple levels were administered a 10-item questionnaire evaluating how often they provided ODE and barriers that limited discussion of opioid disposal with patients. Four open-ended questions were included to inform strategies to facilitate successful implementation of ODE. Text responses were coded using inductive analysis to identify themes. Descriptive statistics were used to analyze quantitative data.
Results: Of 131 patients who responded, 62 (47%) filled an opioid prescription, 47 (36%) received more medication than needed, and only 15 (11%) received opioid disposal education. Of the 47 patients with excess medication, 37 (80%) did not dispose of the excess. The perceived barriers preventing disposal were that they planned to but had not yet (49%), kept the medication for future use (19%), were still taking the medication (5%), and did not know how to perform disposal (3%). Surveys were distributed to 167 providers with response rate of 61%, including 20 surgical faculty, 24 trainees, 19 advanced practice providers, 32 nurses, 9 outpatient pharmacists, and 2 medical assistants. Of 107 providers responding, 79 (74%) rarely or never provided ODE. All providers felt it was important to educate patients about proper disposal techniques. Perceived barriers to ODE were lack of awareness (57%), inadequate knowledge to provide education (39%), and time constraints (20%). Common themes emerging from free text responses as potential solutions to facilitate ODE included: (1) Provider education facilitates patient education; (2) Multiple providers should reinforce education across the care continuum; and (3) Standardization of patient resources improves consistency in messaging.
Conclusion: Disposal of excess opioids in this endocrine surgery population is low with multifactorial barriers to opioid disposal perceived by both patients and providers. Patient engagement and empowerment through education must start with increased ODE of providers. Future work will explore innovative yet simple and achievable methods to facilitate ODE with an endpoint of actual opioid disposal.