OUCH: An evaluation of Opioid Use in Current Hospitalised surgical patients 


Claire Mok, Camila De La Rosa, Aishah Bhadelia and Christopher Mumme 

Objectives 

The rise in use of prescription opioids is well described in Australia, with a five-fold increase seen in the past decade. Literature has described an association between a “trigger” event in opiate naive patients, commonly surgery and the risk of developing long term, persistent opioid use. Unfortunately, there has been burgeoning rates of opioid addiction, dependence and abuse, compounded by adverse effects including opioid induced hyperalgesia, and death. 

Design 

This project is a retrospective cohort analysis looking at the number of surgical patients who were discharged on opioids and the proportion who were provided a de-prescribing plan over a one month period from January to February 2019. Only patients who underwent a surgical intervention, and had a length of stay of more than 1 day were included. Obstetric and gynaecology patients were not included in this study. From this data, we hope to evaluate the appropriateness of opioid prescription, defined as follows: firsts, a provision of opioids only if they had used prescribed pro-re-nata opioids 24-48 hours prior to discharge; second, prescription of opioids in the context of multimodal analgesia with regular paracetamol and/or NSAIDS; and last, the provision of a de-prescribing plan.  

Results 

Of the 26 patients identified who were prescribed opioid analgesics on discharge, 8% had a de-prescribing plan in the discharge documentation, 20% had been on opioids prior to admission, and 62% were prescribed concomitant simple oral analgesics. 

Conclusion 

This project is a pilot study for future research which will aim to estimate and evaluate the magnitude of inappropriate opioid prescription to surgical patients, a problem that is compounded by the lack of opioid de-prescribing plans. Data will be evaluated over a 3-6 month period. This will form the basis of future recommendations in identifying at risk groups, and need for junior doctor education to change prescribing practices to tackle the issue in the local community.