New guidelines set by the Michigan Opioid Prescribing Engagement Network (OPEN) and implemented by hospitals around the state have allowed surgeons to reduce the amount of opioids they prescribe to patients post-surgery. Patients didn’t report increased pain; in fact, patients reported the same amount of pain as patients did with more opioids.
Forty-three hospitals around the state implemented these new, evidence-based prescribing recommendations set by Michigan OPEN. The recommendations originally outlined prescription guidelines for nine different surgeries, but the team has since added 15 other common procedures to the list.
Joceline Vu is a general surgery resident at the University of Michigan and one of the researchers conducting a study on these guidelines for prescribing opioids. She says the procedures listed in the guidelines include three types of gallbladder surgery, appendix removal, colon surgery, hernia repair, and three different types of hysterectomies.
“We called a bunch of patients after each different type of surgery, and asked them how many pills they took," Vu said. "And then we set a number of pills that would cover the 75th percentile of what people took after surgery.”
She says patient centered treatment was a huge part of conducting the study.
“We want to take the best care of their pain as we possibly can, but we also really want to decrease the exposure that they have to these risky medications that can lead to some really long term complications like dependence, or addiction, even,” Vu said.
A team of researchers from Michigan OPEN looked at prescription data from 11,716 patients from hospitals around the state, and just over half filled out surveys regarding their pain. In a year, those 43 hospitals were able to reduce their opioid prescriptions for post-surgery patients by a third, going from an average of 26 to 18 pills.
Patients who responded to the survey rated their pain the same as the patients surveyed in the six month period before the new guidelines were implemented. These patients reported that they only took about half of the opioids prescribed to them, even as the prescriptions got smaller and smaller.
Michael Englesbe is a professor of surgery at the University of Michigan and a co-director of Michigan OPEN. He attributes this decrease in prescriptions to two main factors.
“We were able to write for fewer pills for a couple reasons. One is we were giving too many pills, way too many pills as a profession, surgeons were giving too many pills," Englesbe said. "Two is we weren’t educating patients about the risks of those pills and we weren’t educating patients about surgical pain. Surgery hurts, they should expect to have some pain. There are other medications that are not opioids that can assist in helping patients manage that pain.”
Englesbe adds, “Opioids are totally appropriate after surgery, don’t get me wrong, but only for a couple days and then patients really stop taking them, unless under really unique circumstances. I think it was a combination of good research and really listening to our patients and our partners at the bedside and trying to use best evidence to take the time to educate patients and providers in the state.”
Vu says that the guidelines set in Michigan could easily be replicable in other states, and hopes that other healthcare systems will be able to find it useful.
“We’ve already done the work of calling thousands and thousands of patients at this point, and asking them how many pills they need after surgery, so a lot of places don’t need to expend that time and create guidelines of their own for these procedures.” That way, she says “hospitals in different states can spend their resources gathering their own data on what they’re actually doing. How much are they prescribing? Are they prescribing huge amounts? Is there variability between different clinicians and how much they’re prescribing?”
Englesbe says there’s still a lot of work to be done when it comes to helping patients understand pain.
“This is all about, first and foremost, listening to patients, and appreciating the fact that we as nurses and doctors were not doing a good enough job at taking care of pain, and as a result, people were left stuck on opioids," Vu said. "It’s really all about the best care for patients, I think that’s really important. It’s a lot more complicated than just giving fewer pills. There’s a lot of care that needs to happen to facilitate pain care with fewer pills.”