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TCPI Success Story: Cardiovascular Surgeons Group Initiated Development of Opioid Step-Down Protocols with Hospital

In November 2017, VCSQI sent out an Opioid Prescribing Survey to its TCPI program participants.  In completing and reviewing the survey responses for his six surgeons at Cardiovascular Surgeons Group (Orlando, FL), CEO Steve Dickson learned that:

  • There were no existing opioid prescribing standards in place, and
  • There is wide variation in prescribing practices amongst the surgeons.

On February 7, 2017, Ivan Berkel and Eddie Fonner met with Steve and two CSG nurses to review the survey results, discuss current opioid prescribing practices, and begin to develop opioid prescribing standards to share with the surgeons.

During a 3-hour meeting, the nurses provided an effective overview of the patient pathway from Surgery to Post-Discharge Visit.  Their experience with post-surgical care and pain thresholds shed light on the following:

  • In surgical practice, opioid prescribing variation is normal and sometimes necessary as a result of:
    • Type of surgery
    • Patient weight, age, history, and pain tolerance levels, or medication absorption rates
    • Medication availability and/or dosing options.
  • Protocols do exist in the hospital, however practices do not always have access to them.

As a result of the discussion and nursing insights, Cardiovascular Surgeons Group proposed the following recommendations  to the hospital:

  • Develop Step-Down Protocols for 3 specific surgery types with Hospital Care Coordinators, Pharmacy, Hospital Medicine and Pain Management for the following:
    • Sternotomy
    • Thoracotomy
    • Subcutaneous
  • Develop and use shared patient education with Hospital Care Coordinators.

The recommendations were accepted and the first meeting with the hospital multi-disciplinary group to develop Opioid Step-Down Protocols is scheduled for February 26, 2017.

Photo: Steve Dickson reviewing Patient Flow Map.

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