Opioid deprescribing in thoracic surgical patients at Nottingham University Hospitals

ABSTRACT

Opioid prescriptions have been increasing in England;it is postulated that the use of peri-operative opioids can contribute to prolonged community use [1, 2]. We conducted a quality-improvement project to assess opioid use within our thoracic surgical population. Subsequently, we have introduced several changes in the patient pathway to optimise opioid prescriptions, which have been adopted at a Trust level. Methods Using digital health records, we conducted a retrospective analysis of 74 patients undergoing thoracic procedures between December 2018 and February 2019. We recorded opioid requirements in the 24 h before discharge and details of prescriptions on discharge, including type, dose and length. Results Out of 74 patients, 21 had no short-acting opioid requirements and 16 had no long-acting opioid requirements in the 24 h before discharge yet 67 patients were discharged on opioids. There was a wide range in short-acting opioid requirements 24 h before discharge 5-200 mg of Shortec and 5-400 mg of Oramorph. Only 12 patients had their long-acting opioids weaned before discharge. Maximal length of discharge prescription was 14 days. Patients did not receive opioid deprescribing advice. Discussion Opioids are one of the most effective acute pain analgesics [1, 2]. As anaesthetists, we have a responsibility to manage acute post-surgical pain whilst ensuring we do not contribute to long-term misuse of opioids. This project highlights that a considerable proportion of patients with no opioid requirement are receiving potentially unnecessary prescriptions on discharge. We discussed our findings with thoracic surgeons at governance meetings. We redesigned the Trust opioid patient leaflet alongside pharmacists to improve patient understanding and delivered targeted teaching sessions to doctors responsible for discharge prescriptions. Teaching aimed to increase their confidence in assessment and weaning of opioids. COVID-19 has necessitated an increase in the duration of discharge prescriptions to avoid unnecessary further contact for vulnerable patients. Therefore, it is imperative that patients are also fully informed regarding appropriate use and tapering of opioids. It is the failure to educate regarding the cessation of opioids, rather than the necessary use of opioids in the immediate postoperative period, which contributes to chronic abuse in the community. We plan to review opioid prescriptions again in 6 months.