Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-10-2019

Graduate Advisor

Alicia Hutchings PhD, RN, CNE

Committee

Laura Kuensting, DNP, APRN, PCNS-BC, CPNP, CPEN

Roselyn Lampkins, MD

Abstract

Problem: Opioid abuse may be a result of overprescribing opioids. There are no opioid prescribing recommendations for minor gynecologic surgery. As a result, there is a wide variation in prescribing practices at a privately-owned surgery center where excessive opioid prescription occurs.

Methods: A quality improvement initiative with a descriptive, cohort design. A retrospective review of medical records and telephone surveys over three months resulted in the development of a series of posters describing prescription data for three procedures: hysteroscopy dilation and curettage (HDC), uterine ablation (UA), and laparoscopy (LAP). The trends and changes in opioid prescription practices were displayed throughout the surgery center every month.

Results: A total on 526 medical records were reviewed (N=526) with HDC (n=358); UA (n=95); and LAP (n=73), and 45 telephone surveys were completed (N=45) with HDC (n=18); UA (n=9); and LAP (n=18). The number of patients receiving a prescription for opioids following HDC decreased from 23.3% to 16.4% (p = .001). When opioids were prescribed following HDC, UA, and LAP the mean milligrams of morphine equivalents (MMEs) prescribed decreased 34%, 19%, and 14%, respectively. Results were significant at the p < .05 level for all groups (HDC: p=.001; UA: p=.034; LAP: p= .039).

Implications for practice: Opioid prescribing following monthly publications of prescribing practice and self-reported patient usage decreased the number of opioids prescribed. Monitoring prescribing practices and regular patient surveys may assist in changing prescription practices and may be a reasonable option to decrease excessive opioid prescription at specialty surgery centers.

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