Discharge opioid prescribing guideline among the urological surgery patient population

Background: Among the urological surgery patient population, the conventional opioid prescribing practice is arbitrary, provider preferential, and is not data-driven. The current prescribing practice can result in over-prescription, chronic opioid use, and surplus of opioid analgesics that can be a convenient source of diversion. Purpose: The purpose of the Doctor of Nursing Practice project is to develop and implement a discharge opioid prescribing guideline based on the procedure-specific inpatient opioid requirement. The primary outcome is the reduction of opioid prescription quantity at the time of discharge. The secondary outcome is the adequacy of pain control after discharge. Methods: The guideline was created by performing a retrospective analysis of the prospectively collected post-operative pain data and calculating the daily procedure-specific inpatient opioid requirement. A 5-day dose taper beginning on discharge day number one was incorporated, and the utilization of Prescription Drug Monitoring Programs was integrated into the guideline. Evaluation: Comparison of the pre- and post-implementation refill rates was performed. Data on pain control adequacy were collected using an electronic survey. The between-group difference in demographic data, mean inpatient opioid requirement, and mean discharge opioid prescription were analyzed using an independent samples t-test. Chi-square test was used to determine the between-group difference in the proportion of opioid refill. The percentage distribution of the post-discharge opioid surplus, readmission rate, and self-reported pain control adequacy was also calculated. Results: The Doctor of Nursing Practice project significantly decreased discharge opioid prescribing. Reduction in discharge opioid prescribing was associated with the expected increase in opioid refill that was negated by the favorable self-reported pain control rating, absence of readmission due to acute pain episode, and low opioid utilization after discharge. Clinical Implication: The Doctor of Nursing Practice project will minimize variability in prescribing practices, individualize opioid prescription by accounting for the procedure-specific pain burden, and reduce the rate of opioid prescription at discharge by providing a point of care procedure-specific prescribing guideline among the urological surgery patient population.