妇科手术后的处方实践。

Rachel J Craven, Madeline K Moureau, Heidi W Brown, Emily M Buttigieg
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引用次数: 0

摘要

背景:在美国,用于术后疼痛的阿片类药物处方超过了患者的需求,在阿片类药物流行病中扮演了重要角色。在该项目的干预前阶段(2018 年 9 月至 2019 年 3 月),病历审查和患者调查显示,患者在妇科手术后开出的阿片类药物处方数量是其消耗量的两倍:目的:确定根据术后阿片类药物使用情况推荐阿片类药物处方的教育干预措施是否会减少妇科外科医生的阿片类药物处方:方法:2021 年 1 月实施的一项教育干预传达了患者需求与处方药物之间的差异,并针对常见妇科手术提出了处方建议。干预后(2021 年 2 月至 2021 年 4 月)的回顾性病历审查确定了术后阿片类药物的处方做法。2021 年 6 月,对住院医生的处方实践进行了调查。对每个阶段进行了描述性统计比较:对于腹腔镜子宫切除术,干预前的吗啡毫克当量(MME)中位数为 150(IQR 112.5-166.9),干预后为 150(IQR 112.5-150)。阴道子宫切除术的中位毫克当量从 150(IQR 112.5-225)降至 112.5(IQR 112.5-150)。对于不进行子宫切除术的腹腔镜手术,干预前(IQR 75-120)和干预后(IQR 60-80)的中位数MME均为75。不进行子宫切除术的阴道手术的中位 MME 从 75(IQR 75-142.5)降至 54(IQR 22.5-112.5)。宫腔镜检查和扩张刮宫术的中位 MME 均为 0。在接受调查时,住院医师报告的处方量低于实际处方量:结论:尽管教育告知妇科外科医生阿片类药物的处方量超出了患者的需求,但处方做法并没有改变。实际处方与住院医师报告的处方之间的差异值得进一步调查。
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Postoperative Prescribing Practices Following Gynecologic Surgery.

Background: Opioids prescribed for postoperative pain have exceeded patient need in the United States, playing a significant role in the opioid epidemic. In the preintervention phase of this project (September 2018 - March 2019), a chart review and patient survey revealed that patients were prescribed double the number of opioids they consumed following gynecologic surgery.

Objective: To ascertain whether an educational intervention recommending opiate prescriptions based on postoperative opioid use decreases gynecologic surgeons' opiate prescriptions.

Methods: An educational intervention implemented in January 2021 communicated the discrepancy between patient need and medications prescribed and made prescribing recommendations for common gynecologic procedures. A postintervention (February 2021 - April 2021) retrospective chart review ascertained postoperative opioid prescribing practices. Residents were surveyed about their prescribing practices in June 2021. Descriptive statistics compared each phase.

Results: For laparoscopic hysterectomy, the median morphine milligram equivalent (MME) was 150 (IQR 112.5-166.9) for preintervention and 150 (IQR 112.5-150) postintervention. For vaginal hysterectomy, median MME declined from 150 (IQR 112.5-225) to 112.5 (IQR 112.5-150). For laparoscopic surgery without hysterectomy, the median MME was 75 for both preintervention (IQR 75-120) and postintervention (IQR 60-80). For vaginal surgery without hysterectomy median MME went from 75 (IQR 75-142.5) to 54 (IQR 22.5-112.5). Median MME for hysteroscopy and dilation and curettage was 0 for both phases. When surveyed, residents reported prescribing lower amounts than actual prescribing practices.

Conclusions: Despite education informing gynecologic surgeons that their opioid prescribing exceeded patient need, prescribing practices did not change. The difference between actual and resident-reported prescribing practices warrants further investigation.

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