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In 2019 and 2020, the MI OPEN recommendation for opioid prescribing post carotid endarterectomy (CEA) was 0-10 pills; no prescribing recommendations were outlined for EVAR patients. At Henry Ford Hospital Detroit, opioid naïve CEA patients were prescribed with 0 – 40 pills at discharge, and 0-28 pills for opioid naïve EVAR patients at discharge in 2019. Further review of 2019 data revealed that 82%-90% of opioid naïve CEA patients were discharged with a maximum of 10 pills and 64%-89% of opioid naïve EVAR patients were discharged with a maximum of 10 pills. Although the site was performing well, with only one quarter not meeting the 2020 P4P QI goal of ≥ 70% for opioid prescribing, this project was chosen as the QI project with the goal of maintaining or improving performance. There was no opioid prescribing program in 2019.
Physician champion Dr. Timothy Nypaver, Dr. Paul Corcoran, Millanie Villareal, BSN RN, Kim Finch, MSN, and the vascular surgery team came together to work on this project.
The project, along with 2019 baseline data, was introduced to the vascular and neuro teams. An email was sent to those who were overprescribing as a reminder that the recommendation for prescribing is 0 -10 pills. Oncoming residents were educated on prescribing guidelines. Additionally, the team conducted random patient satisfaction surveys of the use of a multimodal pain management plan and found that there was no difference in satisfaction between patients who were and were not receiving opioids.
The success of the project is evident in the 2020 Q3 performance: 77.8% of opioid naïve EVAR patients were prescribed with <10 pills and 100% of opioid naïve CEA patients were prescribed with <10 pills.