"Right Size" opioid prescribing

Our goal for this quality improvement initiative is to develop prescribing guidelines that meet patients’ needs and reduce unused opioid tablets.

Funded by the FDA's Safe Use Initiative, our multidisciplinary team at Penn Medicine, built, rigorously tested, and deployed an automated text messaging program for postoperative patient engagement. Patients voluntarily self-report acute opioid use and pain intensity over 3 weeks via text message. This system provides a way to capture patient-reported outcomes and opioid use in real time. This data is used to develop patient-informed and procedure-specific short-term opioid guidelines aimed at reducing the number of unused opioid tablets following surgery.

our Approach

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Patients undergo a surgical procedure and receive a prescription for opioids at discharge.

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They are enrolled in our automated texting program that will ask about opioid consumption and pain management.

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Patients are automatically texted every few days postoperatively until they no longer report taking any opioids.

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We compare the patient data with the prescription data and report back to physicians with tailored prescribing reccomendations.

Case Example
Orthopaedic surgery

Using our texting program, we found that, despite marked progress in opioid stewardship, over 61% of opioid tablets prescribed after orthopaedics procedures went unused. We now feed these data back to surgical clinicians to help optimize post-operative opioid prescribing.

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Collaborators

Zarina Ali, MD, MS - Neurosurgery

Anish Agarwal, MD, MPH - Emergency Medicine

Daniel Lee, MD - Urology

Publications

Agarwal AK, Lee D, Ali Z, Sennett B, Xiong R, Hemmons J, Spencer E, Abdel-Rahman D, Kleinman R, Lacko H, Horan A. Patient-Reported Opioid Consumption and Pain Intensity After Common Orthopedic and Urologic Surgical Procedures With Use of an Automated Text Messaging System. JAMA network open. 2021 Mar 1;4(3):e213243-.
 

Agarwal AK, Ali ZS, Sennett B, Xiong R, Hemmons J, Spencer E, Lacko H, Hume E, Mehta S, Delgado MK. An automated text messaging program to inform postoperative opioid prescribing. NEJM Catalyst Innovations in Care Delivery. 2021 Feb 17;2(3).