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Evaluation of a Safer Opioid Prescribing Protocol (SOPP) for Patients Being Discharged From a Trauma Service

Baird, Janette, PhD; Faul, Mark, PhD, MA; Green, Traci C., PhD, MSc; Howland, Jonathan, PhD; Adams, Charles A. Jr, MD, FACS, FCCM; Hodne, Melinda J., APRN, CNP; Bohlen, Nie, MSN, RN; Mello, Michael J., MD, MPH

doi: 10.1097/JTN.0000000000000435
RESEARCH
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The aims of this study were to evaluate the effects on opioid medication prescribing, patient opioid safety education, and prescribing of naloxone following implementation of a Safer Opioid Prescribing Protocol (SOPP) as part of the electronic health record (EHR) system at a Level I trauma center. This was a prospective observational study of the EHR of trauma patients pre- (n = 191) and post-(n = 316) SOPP implementation between 2014 and 2016. At a comparison Level I trauma site not implementing SOPP, EHRs for the same time period were assessed for any historical trends in opioid and naloxone prescribing. After SOPP implementation, the implementation site increased the use of nonnarcotic pain medication, decreased dispensing high opioid dose (≥100 MME [milligram morphine equivalent]), significantly increased the delivery of opioid safety education to patients, and initiated prescribing naloxone. These changes were not found in the comparison site. Opioid prescribing for acute pain can be effectively reduced in a busy trauma setting with a guideline intervention incorporated into an EHR. Guidelines can increase the use of nonnarcotic medications for the treatment of acute pain and increase naloxone coprescription for patients with a higher risk of overdose.

Department of Emergency Medicine (Dr Mello), The Warren Alpert School of Medicine of Brown University (Drs Green and Baird); Division of Trauma and Surgical Critical Care, Department of Surgery (Dr Adams and Ms Bohlen), Injury Prevention Center, Rhode Island Hospital, Providence (Drs Baird and Mello); Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Faul); Department of Emergency Medicine, Boston Medical Center Injury Prevention Center, Boston University School of Medicine, Boston, Massachusetts (Drs Green and Howland); Rhode Island Hospital, University Surgical Associates, Inc., Providence (Ms Hodne); and Department of Health Services, Practice and Policy, Brown University School of Public Health, Providence, Rhode Island (Dr Mello).

Correspondence: Janette Baird, PhD, Injury Prevention Center, Rhode Island Hospital, 55 Claverick St, Providence, RI 02903 (jbaird@lifespan.org).

Contributors: All authors contributed to the original study design, development, and writing of the submitted manuscript.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry.

The authors declare no conflicts of interest.

Copyright © 2019 by the Society of Trauma Nurses.