title: The effect of an educational program on opioid prescription patterns in hand surgery: a quality improvement program.
abstract: OBJECTIVE
  To assess the variability of opioid prescription patterns among hand surgeons in a single practice and to attempt to standardize postoperative prescription sizes based on the patient's surgical procedure.
  
  
  METHODS
  We performed a preliminary chart review to assess the range of prescription sizes for 4 common hand surgery procedures. A group of hand surgeons agreed to write postoperative opioid prescriptions based on an evaluation of historical prescription patterns. An educational assist device (the pink card) was created to serve as a memory prompt and was given to physicians, midlevel practitioners, and trainees. Subsequent chart reviews of number of pills prescribed were done 3 and 15 months later.
  
  
  RESULTS
  After implementation of the pink card, the average postoperative prescription size decreased for all 4 case types by 15% to 48%, reaching statistical significance for 2 of the procedures. Variability in prescription sizes decreased in all cases. There was a trend toward a decreasing number of prescription refills over the course of the study. There was no evidence that patients were obtaining refills from other sources within our multigroup practice.
  
  
  CONCLUSIONS
  Although generalized opioid prescription guidelines exist, they lack specificity. Our multimodal approach using a simple educational-assist device and changes to postoperative order sets significantly affected surgeon behavior without evidence of inadequate treatment of pain.
  
  
  METHODS
  Therapeutic III.
authors.affiliation: Department of Plastic and Hand Surgery, Institute for Education and Research, Regions Hospital, St. Paul, MN; HealthPartners, Bloomington, MN; Office of Education, University of Minnesota School of Medicine, Minneapolis, MN.
authors.forename: Joel J
authors.initials: JJ
authors.lastname: Stanek
authors.affiliation: Department of Plastic and Hand Surgery, Institute for Education and Research, Regions Hospital, St. Paul, MN; HealthPartners, Bloomington, MN; Office of Education, University of Minnesota School of Medicine, Minneapolis, MN.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Renslow
authors.affiliation: Department of Plastic and Hand Surgery, Institute for Education and Research, Regions Hospital, St. Paul, MN; HealthPartners, Bloomington, MN; Office of Education, University of Minnesota School of Medicine, Minneapolis, MN. Electronic address: lkkllnn@aol.com.
authors.forename: Loree K
authors.initials: LK
authors.lastname: Kalliainen
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004502:Education, Medical, Continuing; D019983:Guideline Adherence; D006225:Hand / Q000601:surgery*; D006801:Humans; D019637:Orthopedic Procedures / Q000193:education*; D059408:Pain Management / Q000592:standards*; D010149:Postoperative Pain / Q000188:drug therapy*; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians'; D058996:Quality Improvement
chemical_list: D000701:Analgesics, Opioid
keywords: Attitude of health personnel; education; opioids; physician’s practice patterns; practice guideline