Understanding Opioid Prescribing Practices of Resident Physicians

Background To compare opioid prescribing practices of resident physicians across a variety of surgical and nonsurgical specialties; to identify factors which influence prescribing practices; and to examine resident utilization of best practice supplemental resources. Methods An anonymous survey which assessed prescribing practices was completed by residents from one of several different subspecialties, including internal medicine, obstetrics and gynecology, general surgery, neurosurgery, orthopedic surgery, and urology. Fisher’s exact test assessed differences in prescribing practices between specialties. Results Only 35% of residents reported receiving formal training in safe opioid prescribing. Overall, the most frequently reported influences on prescribing practices were the use of standardized order sets for specific procedures, attending preference, and patient’s history of prescribed opioids. Resident physicians significantly underutilize best practice supplemental resources, such as counseling patients on pain expectations prior to prescribing opioid medication; contacting established pain specialists; screening patients for opioid abuse; referring to the Prescription Monitoring Program; and counseling patients on safe disposal of unused pills ( P < .001). Discussion The incorporation of comprehensive prescribing education into resident training and the utilization of standardized order sets can promote safe opioid prescribing.

Opioid Prescribing Risk Management Opportunities for the Advance Nurse Practitioners

All clinicians are ethically obliged to prescribe responsibly and cautiously to diminish the potential for opioid diversion and to help minimize the growth of the current opioid abuse epidemic. Advance nurse practitioners should establish procedures to better control and limit opioid prescription and develop analgesic regimens to treat pain. The main purpose and goal for this review is to present data congruent with clinical, medical, and legal reports for allowing an appreciation of the possibility of the risk assumed when ordering and prescribing opioids within our podiatry profession. First, the concept and process of risk management as illustrated using a root cause analysis approach will be introduced as well as applying these principles specifically to opioid prescribing will be presented. Then, several examples found in both medical and legal literature documenting the reasons for opioid prescription risk will be presented. Finally, mitigating strategies for safe opioid prescribing will be presented so that mitigation of opioid harm can be possible and realized by the advance nurse practitioner

Opioid Use Disorder: Screening, Diagnosis, and Management

Over the past decade, the opioid crisis in Canada has been worsening. In 2019, over 3,800 people across Canada died due to an apparent opioid-related cause, which represents a 26% increase from just 3 years prior. Given North America’s ongoing opioid crisis, and the contribution opioid-prescribing practices have had to date, a critical need exists to ensure that health care providers are not only educated about safe opioid prescribing but also are knowledgeable about how to effectively screen for, diagnose, and treat an individual with opioid use disorder. RésuméAu cours des dix dernières années, la crise des opioïdes au Canada n’a cessé de s’aggraver. En 2019, plus de 3 800 personnes au Canada sont décédées d’une cause apparemment liée à la consommation d’opioïdes, ce qui représente une augmentation de 26 % par rapport à seulement trois ans auparavant. Étant donné la crise des opioïdes qui sévit actuellement en Amérique du Nord et la contribution des pratiques de prescription d’opioïdes qui ont eu cours jusqu’ici, un besoin critique est à combler pour veiller à ce que les fournisseurs de soins soient non seulement formés sur la prescription sécuritaire des opioïdes, mais aussi bien informés sur le dépistage, le diagnostic et le traitement efficace d’un trouble lié à la consommation d’opioïdes.

Why we still prescribe so many opioids: A qualitative study on barriers and facilitators to prescribing guideline implementation

Introduction: Opioid prescribing occurs within almost every healthcare setting. Implementation of safe, effective opioid stewardship programs represents a critical but daunting challenge for medical leaders. This study sought to understand the barriers and aids to the routine use of clinical guidelines for opioid prescribing among healthcare professionals and to identify areas in need of additional education for prescribing providers, pharmacists, and nurses.Methods: Data collection and analysis in 2018-2019 employed a team of two trained facilitators who conducted 20 focus groups using a structured facilitation guide to explore operational, interpersonal, and patient care-related barriers to best practice adherence. Each professional group was interviewed separately, with similar care settings assigned together. Invitation to participate was based on a sampling methodology representing emergency, medical specialty, primary care, and surgical practice settings.Results: Key concerns among all groups reflected the inadequacy of available tools for staff to appropriately assess and treat patients’ pain. Tools and technology to support safe opioid prescribing were also cited as a barrier by all three professional groups. All groups noted that prescribers tend to rely upon default settings within the electronic medical record when issuing prescriptions. Both pharmacists and prescribers cited time and scheduling as a barrier to adherence.Conclusions: In spite of significant regulatory and public policy efforts to address the opioid crisis, healthcare organizations face significant challenges to improve adherence to best practice prescribing guidelines. These findings highlight several facilitators for change which could boost opioid stewardship initiatives to focus on critical systems’ factors for improvement.