Have we been making our patients dopesick? Removing MR Opioids from our Enhanced Recovery Protocols.

Introduction

In light of growing evidence, we have been challenged to review our perception of Modified Release (MR) Oxycodone and it’s use in orthopaedic Enhanced Recovery Protocols (ERPs).

This led us to consider whether MR Opioids are as essential to postoperative pain as we had been led to believe? Have we been making our patients dopesick?

Objectives

Our aim was to reduce the risk of opioid related harm by removing MR opioids from our orthopaedic ERPs without significantly increasing pain scores or decreasing satisfaction.

Methods

Changing the protocol required approval from Orthopaedic & Anaesthetic Divisional Governance, and Safer Medicine Practice Group meetings.

Retrospective data was collected from 38 lower limb arthroplasty patients notes prior to prescription change. 3 PDSA cycles were conducted subsequently in which during the first PDSA cycle, MR Opioids were replaced by NSAIDs and a short acting weak opioid. Subsequently for 2nd PDSA cycle, PRN buccal Prochlorperazine was added as a rescue anti-emetic. Eventually, regular Senna was added to the prescription to counter constipation and monitoring data is being continuously collected to ensure effective improvement of care.

-Main Improvement measures: Average Oxycodone dose per patient and pain scores.

-Other measures: Analgesia satisfaction scores and time to discharge.

-Balance measures: Side effects like Constipation, Nausea, Vomiting, Dizziness, Hallucinations.

3rd PDSA CYCLE

Summary of Prescription Change

Results

1st PDSA CYCLE CONCLUSION

2nd PDSA CYCLE

Our results showed that average oxycodone dose reduced, pain scores decreased, time to discharge decreased and patients’ analgesia satisfaction improved. Hence we achieved our aim of removing MR Opioids as per national guidelines. Constipation and nausea were initially troublesome, which have been now addressed by adding another rescue anti-emetic and a stimulant laxative.