Postoperative opioid protocol: A 5-year resident-led effort to standardize prescribing patterns

Area of Science:

• Otolaryngology
• Pain Management
• Pharmacology

Background:

• Surgeon prescribing preferences and resident comfort levels create disparities in opioid prescribing.
• Standardizing postoperative prescription practices is crucial for consistent patient care.

Purpose of the Study:

• To update on the expanded scope of a 5-year resident-led initiative to standardize postoperative prescription practices.
• To evaluate the impact of the Expanded Postoperative Analgesia Protocol on opioid prescribing patterns and patient outcomes.

Main Methods:

• Retrospective review of 12 months pre-protocol and 48 months post-protocol implementation.
• Comparison of Pre-Protocol and Expanded Protocol cohorts using ANOVA, chi-squared, and Fisher Exact tests.
• Covariate analysis using ANCOVA and binary logistic regression; cost impact calculated using medication spending data.

Main Results:

• Significant reduction in combination opioid medications (91.3% to 3.8%).
• 66% reduction in average morphine milligram equivalents per patient.
• 74% reduction in postoperative medication costs and 68% reduction in medication refills.

Conclusions:

• Purposeful standardization led to sustained changes in departmental prescribing practices.
• The initiative resulted in reduced variability, lower costs, and improved opioid management.
• The protocol yielded superior pain control for postoperative patients.