Abstract：
BACKGROUND: Deaths related to overdoses continue growing in the United States. The overprescription of opioids after surgical procedures may contribute to this problem.
OBJECTIVE: There is inconsistency in the prescription of opioids in cardiovascular surgery patients. Recommendations regarding the reduction of opioids at discharge are not fully implemented.
METHODS: This is a single-center, pre-post quality improvement project in adult patients after elective cardiac surgery through sternotomy.
METHODS: Changes in guidelines, modification of order sets, creation of dashboards, and education to the providers to increase the prescription of acetaminophen around the clock on the step-down unit and at discharge, decrease the number of opioid tablets to 25 or less at discharge and decrease the prescription of opioids to 25 or less morphine milligram equivalents (MME) at discharge.
RESULTS: The preintervention group included 67 consecutive patients who underwent cardiac surgery from November to December 2021. The postintervention group had 67 patients during the same period in 2022. Acetaminophen prescription on the step-down unit increased from 9% to 96% ( p < .001). The proportion of patients discharged with 25 or less opioid tablets increased from 18% to 90% ( p < .001) and with 25 or less MME from 30% to 55% ( p < .01). Acetaminophen prescription at discharge increased from 10% to 48% ( p < .001).
CONCLUSIONS: Our intervention increased the use of acetaminophen and decreased the overprescription of opioids in cardiac surgery patients at discharge. Further research is necessary to continue improving pain management to reduce the number of opioids prescribed at discharge.
OBJECTIVE: There is inconsistency in the prescription of opioids in cardiovascular surgery patients. Recommendations regarding the reduction of opioids at discharge are not fully implemented.
METHODS: This is a single-center, pre-post quality improvement project in adult patients after elective cardiac surgery through sternotomy.
METHODS: Changes in guidelines, modification of order sets, creation of dashboards, and education to the providers to increase the prescription of acetaminophen around the clock on the step-down unit and at discharge, decrease the number of opioid tablets to 25 or less at discharge and decrease the prescription of opioids to 25 or less morphine milligram equivalents (MME) at discharge.
RESULTS: The preintervention group included 67 consecutive patients who underwent cardiac surgery from November to December 2021. The postintervention group had 67 patients during the same period in 2022. Acetaminophen prescription on the step-down unit increased from 9% to 96% ( p < .001). The proportion of patients discharged with 25 or less opioid tablets increased from 18% to 90% ( p < .001) and with 25 or less MME from 30% to 55% ( p < .01). Acetaminophen prescription at discharge increased from 10% to 48% ( p < .001).
CONCLUSIONS: Our intervention increased the use of acetaminophen and decreased the overprescription of opioids in cardiac surgery patients at discharge. Further research is necessary to continue improving pain management to reduce the number of opioids prescribed at discharge.
摘要：
背景：在美国，与用药过量相关的死亡人数持续增长。外科手术后阿片类药物的过量处方可能会导致此问题。
目的：心血管手术患者阿片类药物的处方存在不一致。关于减少排放阿片类药物的建议没有得到充分执行。
方法：这是一个单中心，通过胸骨切开术进行择期心脏手术的成年患者的质量改进项目。
方法：指南的更改，修改订单集，创建仪表板，并对提供者进行教育，以在降压单元和出院时全天候增加对乙酰氨基酚的处方，出院时将阿片类药物片剂的数量减少到25或更少，出院时将阿片类药物的处方减少到25或更少的吗啡毫克当量（MME）。
结果：干预组包括从2021年11月至12月接受心脏手术的67名连续患者。2022年同期干预组有67例患者。降压单位的对乙酰氨基酚处方从9%增加到96%(p<.001)。使用25或更少的阿片类药物片剂出院的患者比例从18％增加到90％（p<.001），使用25或更少的MME从30％增加到55％（p<.01）。出院时的对乙酰氨基酚处方从10%增加到48%(p<.001)。
结论：我们的干预措施增加了心脏手术患者出院时对乙酰氨基酚的使用，并减少了阿片类药物的过度处方。需要进一步研究以继续改善疼痛管理，以减少出院时处方的阿片类药物数量。
目的：心血管手术患者阿片类药物的处方存在不一致。关于减少排放阿片类药物的建议没有得到充分执行。
方法：这是一个单中心，通过胸骨切开术进行择期心脏手术的成年患者的质量改进项目。
方法：指南的更改，修改订单集，创建仪表板，并对提供者进行教育，以在降压单元和出院时全天候增加对乙酰氨基酚的处方，出院时将阿片类药物片剂的数量减少到25或更少，出院时将阿片类药物的处方减少到25或更少的吗啡毫克当量（MME）。
结果：干预组包括从2021年11月至12月接受心脏手术的67名连续患者。2022年同期干预组有67例患者。降压单位的对乙酰氨基酚处方从9%增加到96%(p<.001)。使用25或更少的阿片类药物片剂出院的患者比例从18％增加到90％（p<.001），使用25或更少的MME从30％增加到55％（p<.01）。出院时的对乙酰氨基酚处方从10%增加到48%(p<.001)。
结论：我们的干预措施增加了心脏手术患者出院时对乙酰氨基酚的使用，并减少了阿片类药物的过度处方。需要进一步研究以继续改善疼痛管理，以减少出院时处方的阿片类药物数量。
