W. J. Peppard1, B. S. Karam1, A. Elegbede1, C. Trevino1 1Medical College Of Wisconsin,Division Of Trauma And Acute Care Surgery,Milwaukee, WI, USA
Introduction: It is well established that patients prescribed higher opioid dosages are at a higher risk of overdose and death despite achieving no added long-term pain reduction. Yet increases in opioid prescribing continue to fuel the epidemic in the US. We hypothesized that implementing a comprehensive guideline to standardize opioid prescribing would decrease the dosages prescribed at discharge for trauma patients.
Methods: This quasi-experimental study compared opioid prescribing by trauma providers before and after the implementation of a departmental guideline on April 1, 2019, aimed at aligning opioid prescription patterns with CDC recommendations. Patients prescribed opioids between April and December 2018 were assigned to the control group, whereas those prescribed opioids between April and December 2019 were assigned to the intervention group. Our primary outcome was the proportion of patients receiving ≥ 50 Morphine Milligram Equivalents (MME) per day. A subgroup analysis of patients age ≥ 64 years was performed. Chi squared and Mann-Whitney U test were used to compare the two groups.
Results: We identified 560 and 535 trauma patients in the control and intervention group, respectively. Total MME and maximum MME per day were 7% and 50% lower, respectively, in the intervention group as compared to the control group (p<0.001). The proportion of trauma patients prescribed ≥ 50 MMEs per day decreased from 66% to 22% after policy implementation (p<0.001). The proportion of trauma patients prescribed ≥ 90 MMEs per day also decreased, from 53% to 18% (p<0.001). The median supply of opioids increased from 3 to 3.3 days over the same period (p=0.004). There was no change in the proportion of patients receiving a supply of > 7 days (Table 1). Lower total MME, maximum MME, and proportion of trauma patients prescribed ≥ 50 and ≥ 90 MMEs per day was again seen in the subgroup of patients ≥ 64 years old.
Conclusion: A departmental guideline aimed at optimizing opioid prescription patterns is successful in lowering the amount of MMEs prescribed to trauma patients and thereby improving compliance with CDC best practice recommendations.
