Background: Opioid misuse and abuse is a rapidly growing epidemic in the United States and affects approximately two million individuals. There were an estimated 165,000 deaths between 1999 and 2014 that were related to prescription opioid overdoses. In 2016, over 42,000 opioid-related deaths were reported. Prescribers contribute to the problem by overprescribing opioids and this behavior requires intervention. The purpose of this study was to assess the prescribing practices of practitioners at a Southern California Family Practice and implement a policy to improve their prescribing practices with the recommendations set forth in the Centers for Disease Control and Prevention (CDC) 2016 guidelines.
Methods: An opioid prescribing policy was developed for the organization. Retrospective chart reviews were conducted for three months pre and post-policy implementation. Inclusion criteria were adults ages 18 and older that were prescribed an opioid by a clinician within the organization. Patients on palliative care, a diagnosis of cancer, or under the age of 18 were excluded. Data was collected for six variables pre and post-policy implementation: (1) documentation of the Controlled Substance Utilization and Review System (CURES) report in the chart, (2) reviewed the CURES report documented, (3) a copy of the written prescription in the chart, (4) written after hours, (5) a prescription written for less than seven days, and (6) a diagnosis associated with the written prescription. Three of the six variables showed statistical significance (p < 0.05). McNemar Chi square statistics were used for data analysis. A power analysis was conducted using Number Cruncher Statistical System (NCSS) Power Analysis and Sample Size (PASS) software version 2.0 and N= 51 for a power of 90% statistical significance.
Results: The implementation of an opioid prescribing policy proved effective in increasing prescriber adherence as evidenced by statistically significant results in three of the six variables measured. Prescriber adherence of the CURES report being placed in the chart was 5.8% (3 charts) pre-policy implementation and 33.3% (17 charts) post-policy implementation. McNemar value 12.2500 and p = 0.00047, (DF1, 7.879). CURES report placed in the chart, 7.8% (4 charts) pre-policy implementation and 31.4% (16 charts) post-policy implementation. McNemar value 10.2857, p = 0.00134, (DF 1, 7.879). A copy of the written prescription in the chart was 15.7% (8 charts) pre-policy implementation and 49.0% (25 charts) post-policy implementation. McNemar value 12.5652, p = 0.00039, (DF 1, 7.879).
Conclusions: The increasing awareness of opioid addiction and the rising death rates heighten the need to promote a culture of safety among prescribers. The results of the study demonstrated that having a policy in place that provides parameters for prescribing positively impact the prescribing practices of clinicians in the outpatient primary care practice setting.
|Advisor:||Stone, Dawn S.|
|Commitee:||Mancuso, Scott, Lincoln-Giang, Pam|
|School:||Western University of Health Sciences|
|Department:||College of Graduate Nursing|
|School Location:||United States -- California|
|Source:||DAI-B 81/9(E), Dissertation Abstracts International|
|Keywords:||Opioid, Policy, prescribing practice|
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