Advertisement

Stakeholder Perspective on Opioid Stewardship After Prostatectomy: Evaluating Barriers and Facilitators From the Pennsylvania Urology Regional Collaborative

      Abstract

      OBJECTIVE

      To evaluate existing practice patterns and potential barriers to implementing opioid stewardship protocols after robot-assisted prostatectomies among providers in the Pennsylvania Urology Regional Collaborative.

      METHODS

      The Pennsylvania Urology Regional Collaborative (PURC) is a voluntary quality improvement initiative of 11 academic and community urology practices in Pennsylvania and New Jersey representing 97 urologists. PURC distributed a web-based survey of 24 questions, with 74 respondents, including 56 attendings, 11 residents, and 7 advanced practice providers.

      RESULTS

      More pills were prescribed if there was a default number of pills from the electronic health record (median 30) then if the number of pills was manually placed (P = .01). Only 8% discussed how to dispose of opioids with their patients, and less than a third of respondents discussed postoperative pain expectations or risks of opioid use. Patient level risk factors were often not reviewed, as 42% did not ask about previous opioid exposure.

      CONCLUSION

      This study revealed extensive knowledge disparities among providers about opioid stewardship and significant gaps in the evidence-to-practice continuum of care. In the next year, PURC will be implementing targeted interventions to augment provider education, establish clear pathways for opioid disposal, improve utilization of known resources and implement opioid reduction protocols in all participating sites.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. “What is the U.S. Opioid Epidemic?”; U.S. Department of Health and Human Services.https://www.hhs.gov/opioids/about-the-epidemic/index.html. Accessed October 1, 2018.

      2. “The Opioid Threat in Pennsylvania” Joint Intelligence Report. Drug Enforcement Agency and University of Pittsburgh. DEA-PHL-DIR-036-18.https://www.dea.gov/sites/default/files/2018-10/PA%20Opioid%20Report%20Final%20FINAL.pdf. Accessed October 18, 2018.

        • Callinan CE
        • Neuman MD
        • Lacy KE
        • Gabison C
        • Ashburn MA
        The initiation of chronic opioids: a survey of chronic pain patients.
        J Pain. 2017; 18: 360-365
        • Bartels K
        • Mayes LM
        • Dingmann C
        • Bullard KJ
        • Hopfer CJ
        • Binswanger IA
        Opioid use and storage patterns by patients after hospital discharge following surgery.
        PLoS One. 2016; 11e0147972
        • Hill MV
        • McMahon ML
        • Stucke RS
        • Barth RJ
        Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures.
        Ann Surg. 2017; 265: 709-714
        • Howard R
        • Waljee J
        • Brummett C
        • Englesbe M
        • Lee J
        Reduction in opioid prescribing through evidence-based prescribing guidelines.
        JAMA Surg. 2018; 153: 285-287
        • Patel HD
        • Srivastava A
        • Patel ND
        • et al.
        A prospective cohort study of postdischarge opioid practices after radical prostatectomy: the ORIOLES initiative.
        Eur Urol. 2018; 75: 215-218
        • Shkolyar E
        • Shih IF
        • Li Y
        • Wong JA
        • Liao JC
        Robot-assisted radical prostatectomy associated with decreased persistent postoperative opioid use.
        J Endourol. 2020; 34: 475-481
        • Talwar R
        • Xia L
        • Serna J
        • et al.
        Preventing excess narcotic prescriptions in new robotic surgery discharges: the PENN prospective cohort quality improvement initiative.
        J Endourol. 2020; 34: 48-53
        • Bicket MC
        • Long JJ
        • Pronovost PJ
        • Alexander GC
        • Wu CL
        Prescription opioid analgesics commonly unused after surgery: asystematic review.
        JAMA Surg. 2017; 152: 1066-1071
        • Bates C
        • Laciak R
        • Southwick A
        • Bishoff J
        Overprescription of postoperative narcotics: a look at postoperative pain medication delivery, consumption and disposal in urological practice.
        J Urol. 2011; 185: 551-555
        • Shei A
        • Rice JB
        • Kirson NY
        • et al.
        Sources of prescription opioidsamong diagnosed opioid abusers.
        Curr Med Res Opin. 2015; 31: 779-784
        • Holman JE
        • Stoddard GJ
        • Horwitz DS
        • Higgins TF
        The effect of preoperative counseling on duration of postoperative opiate use in orthopaedic trauma surgery: a surgeon-based comparative cohort study.
        J Orthop Trauma. 2014; 28: 502-506
        • Luk LJ
        • Mosen D
        • MacArthur CJ
        • Grosz AH
        Implementation of a pediatric posttonsillectomy pain protocol in a large group practice.
        Otolaryngol Head Neck Surg. 2016; 154: 720-724
        • Prabhu M
        • McQuaid-Hanson E
        • Hopp S
        • et al.
        A shared decision-making intervention to guide opioid prescribing after cesarean delivery.
        Obstet Gynecol. 2017; 130: 42-46
        • Wetzel M
        • Hockenberry J
        • Raval MV
        Interventions for postsurgical opioid prescribing: a systematic review.
        JAMA Surg. 2018; 153: 948-954
        • Noguchi S
        • Saito J
        • Nakai K
        • Kitayama M
        • Hirota K
        Efficacy of abdominal peripheral nerve block and caudal block during robot-assisted laparoscopic surgery: a retrospective clinical study.
        J Anesth. 2019; 33: 103-107
        • Dal Moro F
        • Aiello L
        • Pavarin P
        • Zattoni F
        Ultrasound-guided transversus abdominis plane block (US-TAPb) for robot-assisted radical prostatectomy: a novel ‘4-point’ technique-results of a prospective, randomized study.
        J Robot Surg. 2019; 13: 147-151
        • Cacciamani GE
        • Menestrina N
        • Pirozzi M
        • et al.
        Impact of combination of local anesthetic wounds infiltration and ultrasound transversus abdominal plane block in patients undergoing robot-assisted radical prostatectomy: perioperative results of a double-blind randomized controlled trial.
        J Endourol. 2019; 33: 295-301
        • Lovely JK
        • Huang LC
        • Meyers AJ
        • Spears GM
        • Huebner M
        • Larson DW
        Post-surgical opioid prescribing patterns and risk factors for additional opioid prescriptions within one year after non-emergent colorectal surgery.
        Am J Surg. 2019; 218: 56-61
        • Cron DC
        • Englesbe MJ
        • Bolton CJ
        • et al.
        Preoperative opioid use is independently associated with increased costs and worse outcomes after major abdominal surgery.
        Ann Surg. 2017; 265: 695-701
        • Shah A
        • Hayes CJ
        • Martin BC
        Characteristics of initial prescription episodes and likelihood of long-term opioid use - United States, 2006-2015.
        MMWR Morb Mortal Wkly Rep. 2017; 66: 265-269
        • Waljee JF
        • Cron DC
        • Steiger RM
        • Zhong L
        • Englesbe MJ
        • Brummett CM
        Effect of preoperative opioid exposure on healthcare utilization and expenditures following elective abdominal surgery.
        Ann Surg. 2017; 265: 715-721
        • Brady JE
        • Wunsch H
        • DiMaggio C
        • Lang BH
        • Giglio J
        • Li G
        Prescription drug monitoring and dispensing of prescription opioids.
        Public Health Rep. 2014; 129: 139-147
        • Jena AB
        • Goldman D
        • Weaver L
        • Karaca-Mandic P
        Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims.
        BMJ. 2014; 348: g1393
        • Grecu AM
        • Dave DM
        • Saffer H
        Mandatory Access Prescription Drug Monitoring Programs and Prescription Drug Abuse.
        J Policy Anal Manage. 2019; 38: 181-209
        • Strickler GK
        • Zhang K
        • Halpin JF
        • Bohnert ASB
        • Baldwin GT
        • Kreiner PW
        Effects of mandatory prescription drug monitoring program (PDMP) use laws on prescriber registration and use and on risky prescribing.
        Drug Alcohol Depend. 2019; 199: 1-9
        • Reifler LM
        • Droz D
        • Bailey JE
        • et al.
        Do prescription monitoring programs impact state trends in opioid abuse/misuse?.
        Pain Med. 2012; 13: 434-442
        • Patel MS
        • Navathe AS
        • Liao JM
        Using Nudges to Improve Value by Increasing Imaging-Based Cancer Screening.
        J Am Coll Radiol. 2020; 17: 38-41
        • Sharma S
        • Guttmann D
        • Small DS
        • et al.
        Effect of introducing a default order in the electronic medical record on unnecessary daily imaging during palliative radiotherapy for adults with cancer: astepped-wedge cluster randomized clinical trial.
        JAMA Oncol. 2019; 5: 1220-1222