Implementing an evidence-based guideline to decrease opioids after cardiac surgery

Background:Deaths related to overdoses continue growing in the United States. The overprescription of opioids after surgical procedures may contribute to this problem.Local problem: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.Interventions: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.