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Using implementation science to decrease variation and high opioid administration in a surgical ICU.

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  • 1From the Department of Surgery (K.J.K., A.W., J.W.G., R.Y., N.B., J.M., M.R.K., M.K.K., M.L.R., B.L.D., A.P.), University of Arkansas for Medical Sciences; Department of Pharmacology and Toxicology (B.J.B., A.K.J., R.R.S.), University of Arkansas for Medical Sciences; Center for Implementation Research, Department of Pharmacy Practice, and Department of Psychiatry (G.M.C.), University of Arkansas for Medical Sciences.

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Summary
This summary is machine-generated.

Implementation science reduced opioid prescribing in ventilated ICU patients by 20.1%. This approach effectively lowered high-dose opioid use and variation among intensivists, mitigating associated risks.

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Area of Science:

  • Critical Care Medicine
  • Implementation Science
  • Pharmacology

Background:

  • High-dose and prolonged opioid use are linked to adverse outcomes like tolerance, dependence, and mortality.
  • Opioid utilization remains high in intensive care units (ICUs), particularly for ventilated patients, often exceeding necessary pain control levels.
  • This study applied implementation science techniques to address excessive opioid prescribing in a surgical ICU (SICU) setting.

Purpose of the Study:

  • To monitor and reduce excessive opioid prescribing in mechanically ventilated patients within a surgical intensive care unit.
  • To evaluate the effectiveness of implementation science strategies in modifying prescriber behavior.

Main Methods:

  • A prospective study was conducted over 18 months in a closed SICU at an academic medical center.
  • Opioid administration was tracked using morphine milligram equivalents (MME) per patient, excluding specific patient groups.
  • Intensivists received blinded data, followed by academic detailing and audit/feedback comparing their prescribing to unit averages.

Main Results:

  • Opioid utilization in ventilated patients decreased by 20.1% during the intervention period.
  • Prescriber variation significantly reduced, with the highest prescribers showing a 30.9% reduction in opioid use.
  • The study demonstrated a measurable impact of implementation science interventions on opioid prescribing patterns.

Conclusions:

  • Implementation science approaches are effective in reducing opioid prescribing variation in SICUs, particularly for high-volume prescribers.
  • These interventions can potentially mitigate the risks associated with prolonged high-dose opioid administration in critically ill patients.