Preoperative and Postoperative Opioid Prescription Rates in the Total Hip Replacement Surgical Patient.

The United States is facing an opioid epidemic that has only worsened with the COVID-19 pandemic. There is little evidence regarding patterns of opioid use among patients with total hip replacement (THR). Although the Centers for Disease Control and Prevention has put forward guidelines for prescribing opioids, it does not include guidance specifically for THR patients suffering from presurgical and postsurgical pain. The purpose of this study was to (1) compare presurgical and postsurgical opioid rates, (2) compare presurgical and postsurgical morphine milligram equivalents (MME), and (3) determine whether having a presurgical opioid prescription predicts the receipt of postsurgical opioid prescriptions among patients undergoing THR surgery. Retrospective cohort analysis of 4,405 patients undergoing THR at a major academic medical center in the United States from April 30, 2015, to April 30, 2018, was done. Patient characteristics, opioid rates, and average MME/day/person were described. Logistic regression was used to determine whether presurgical opioid prescription and opioid risk level predicted postsurgical opioid prescribing. Median age was 64 years (range = 18-85 years); patients were primarily Caucasian/White (78.8%) and female (54.7%). Opioid prescription rates in this sample for the 12-month presurgical and postsurgical periods were 66.1% and 95.6%, respectively. Oxycodone was the most common opioid prescribed in both periods. Among those prescribed an opioid, moderate/high risk for overdose and/or death was 6.3% presurgery and 19.8% postsurgery. Patients with a comorbidity were two times more likely to receive an opioid prescription in the postsurgical period. The median average MME/day/person was 26.5 (range = 0.3-180.0) for patients with an opioid prescribed during the presurgery period and 40.4 (range = 1.5-270.0) during the postsurgery period. Opioid use, regardless of strength, in the presurgical period as well as having one or more comorbidities predicted opioid use in the postsurgical period.

Creating a culture that values diversity and inclusion: An action-oriented framework for schools of nursing.

An organizational culture that values diversity and inclusion is essential for the achievement of high-quality nursing education, yet little literature exists to guide schools of nursing (SON) in accomplishing this goal. All SONs, regardless of size, need a framework that provides specific steps for developing and nurturing a culture that values diversity and inclusion. Using our SON as an exemplar, the goal of this article was to (a) review the barriers we faced when building a diverse and inclusive environment, (b) share our school's strategic plan designed to promote diversity and inclusion, and (c) highlight successful strategies as part of the development and ongoing implementation of our school's strategic plan. This process requires continuous commitment and intentionality as well as flexibility to address unforeseen circumstances. For example, the goals we have adopted and the strategies we have put in place have allowed members of our SON community to acknowledge and address the urgency and validity of the Black Lives Matter movement, as well as the disproportionate impact of the coronavirus disease 2019 pandemic on racial and ethnic minority groups. Although we recognize that we still have work to do within our SON community, we believe our exemplar offers an action-oriented framework for increasing diversity and inclusion among students, faculty, staff, and leadership in SONs.