Situational Awareness of Opioid Consumption: The Missing Link to Reducing Dependence After Surgery?
Journal
Anesthesia and analgesia
ISSN: 1526-7598
Titre abrégé: Anesth Analg
Pays: United States
ID NLM: 1310650
Informations de publication
Date de publication:
01 09 2022
01 09 2022
Historique:
pubmed:
4
2
2022
medline:
20
8
2022
entrez:
3
2
2022
Statut:
ppublish
Résumé
A tool for collecting and analyzing morphine milligram equivalents (MMEs) can be used to overcome barriers to situational awareness around opioid utilization in the setting of multimodal pain management. Our software application (App) has facilitated data collection, analysis, and benchmarking in a manner that is not logistically feasible using manual methods. Real-time postoperative tracking of MME over the course of an episode of care can be prohibitively labor-intensive, and teams must have practical strategies to overcome this obstacle. In view of the link between the magnitude of opioid prescriptions at discharge and persistent opioid use after cardiac surgery, we believe that improving situational awareness among the patient care team is a vital first step in reducing opioid dependence after cardiac surgery.
Identifiants
pubmed: 35110517
doi: 10.1213/ANE.0000000000005923
pii: 00000539-202209000-00025
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
653-658Informations de copyright
Copyright © 2022 International Anesthesia Research Society.
Déclaration de conflit d'intérêts
Conflicts of Interest: See Disclosures at the end of the article.
Références
Brummett CM, Waljee JF, Goesling J, et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017;152:e170504.
Brescia AA, Waljee JF, Hu HM, et al. Impact of prescribing on new persistent opioid use after cardiothoracic surgery. Ann Thorac Surg. 2019;108:1107–1113.
Brown CR, Chen Z, Khurshan F, Groeneveld PW, Desai ND. Development of persistent opioid use after cardiac surgery. JAMA Cardiol. 2020;5:889–896.
Clement KC, Canner JK, Lawton JS, Whitman GJR, Grant MC, Sussman MS. Predictors of new persistent opioid use after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2020;160:954–963.e4.
Clement KC, Canner JK, Whitman GJR, Lawton JS, Grant MC, Sussman MS. New persistent opioid use after aortic and mitral valve surgery in commercially insured patients. Ann Thorac Surg. 2020;110:829–835.
Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287–2298.
Bernard SA, Chelminski PR, Ives TJ, Ranapurwala SI. Management of pain in the United States-a brief history and implications for the opioid epidemic. Health Serv Insights. 2018;11:1178632918819440.
Rummans TA, Burton MC, Dawson NL. How good intentions contributed to bad outcomes: the opioid crisis. Mayo Clin Proc. 2018;93:344–350.
Neuman MD, Bateman BT, Wunsch H. Inappropriate opioid prescription after surgery. Lancet. 2019;393:1547–1557.
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.
Ray JM, Ahmed OM, Solad Y, et al. Computerized clinical decision support system for emergency department-initiated buprenorphine for opioid use disorder: user-centered design. JMIR Hum Factors. 2019;6:e13121.
Kaafarani HMA, Eid AI, Antonelli DM, et al. Description and impact of a comprehensive multispecialty multidisciplinary intervention to decrease opioid prescribing in surgery. Ann Surg. 2019;270:452–462.
Endsley MR. Theoretical underpinnings of situation awareness: a critical review. Endsley MR, Garland DJ, eds. In: Situation Awareness Analysis and Measurement. Lawrence Erlbaum Associates; 2000:3–21.
Engelman D, Higgins TL, Talati R, Grimsman J. Maintaining situational awareness in a cardiac intensive care unit. J Thorac Cardiovasc Surg. 2014;147:1105–1106.
Ettorchi-Tardy A, Levif M, Michel P. Benchmarking: a method for continuous quality improvement in health. Healthc Policy. 2012;7:e101–e119.
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain–United States, 2016. JAMA. 2016;315:1624–1645.
Nielsen S, Degenhardt L, Hoban B, Gisev N. A synthesis of oral morphine equivalents (OME) for opioid utilisation studies. Pharmacoepidemiol Drug Saf. 2016;25:733–737.
US Department of Health and Human Services, Centers for Disease Control and Prevention. Calculating total daily dose of opioids for safer dosage. Updated February 17, 2021. Accessed November 22, 2021. https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf
Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: enhanced recovery after surgery society recommendations. JAMA Surg. 2019;154:755–766.
Williams JB, McConnell G, Allender JE, et al. One-year results from the first US-based enhanced recovery after cardiac surgery (ERAS Cardiac) program. J Thorac Cardiovasc Surg. 2019;157:1881–1888.
Computational Health Informatics Program (CHIP). SMART. Boston Children’s Hospital. 2020. Accessed August 25, 2020. https://smarthealthit.org/
Mandl KD, Kohane IS. No small change for the health information economy. N Engl J Med. 2009;360:1278–1281.
Bart GB, Saxon A, Fiellin DA, et al. Developing a clinical decision support for opioid use disorders: a NIDA center for the clinical trials network working group report. Addict Sci Clin Pract. 2020;15:4.
Price-Haywood EG, Burton J, Burstain T, et al. Clinical effectiveness of decision support for prescribing opioids for chronic noncancer pain: a prospective cohort study. Value Health. 2020;23:157–163.
Bersani K, Fuller TE, Garabedian P, et al. Use, perceived usability, and barriers to implementation of a patient safety dashboard integrated within a vendor EHR. Appl Clin Inform. 2020;11:34–45.
Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152:292–298.
Salenger R, Morton-Bailey V, Grant M, Gregory A, Williams JB, Engelman DT. Cardiac enhanced recovery after surgery: a guide to team building and successful implementation. Semin Thorac Cardiovasc Surg. 2020;32:187–196.
Elimu Informatics. Post-op opioid MME monitoring. Elimu Informatics website. 2021. Accessed January 15, 2022. https://www.elimu.io/solutions/post-op-opioid-monitoring/