Education of trauma patients on opioids and pain management: A quality improvement project

Abstract

Background: Our acute care surgery team sustainably launched a pain management quality improvement project to reduce opioid prescriptions without affecting pain control in our elective surgery patients that was adopted on the inpatient acute care surgery service. Consequently, we implemented patient education on opioids and pain management aiming at decreasing opioid use without compromising pain management for acutely injured patients on the trauma service.

Methods: Trauma patients admitted from August 1, 2021, to July 31, 2022, and discharged to home were included. Pain management education started on February 2022. Demographics, injury severity scores (ISSs), preadmission opioid and adjunct use, and type/dose of opioids and nonopioid adjuncts prescribed 24 hours predischarge and at discharge were collected. Opioids were converted to oral morphine milligram equivalents (MME). Phone calls for pain and opioid prescription refills were collected. The pre- and posteducation groups were compared using univariate analysis. Multivariate analyses were conducted to identify factors associated with phone calls for pain and opioid refills.

Results: Three hundred sixty-eight patients were included, 200 pre- and 168 posteducation. MME prescribed at discharge was positively associated with 24-hour predischarge MME (B = 0.010 [0.007-0.012], P < .001) and negatively associated with preinjury opioid use (B = -0.405 [-0.80 to -0.008], P = .045). Patient education led to an increased number of adjuncts prescribed (P < .008), decreased phone calls for pain (OR = 0.356 [0.165-0.770], P = .009), and decreased opioid refills (OR = 0.297 [0.131-0.675], P = .004), but no change in opioid prescriptions.

Conclusion: Patient education on opioids and pain management led to decreased phone calls for inadequate pain management and decreased number of opioid refills.