Post-Discharge Opioid Reduction Intervention for Open, Laparoscopic, and Endoscopic Surgery
Condition: Prostate Cancer; Opioid Use
MeSH terms: Prostatic Neoplasms
Study type: Interventional

Summary: 
      ORIOLES is a non-randomized, pre-post intervention study designed to improve quality of
      opioid prescribing and use after discharge for patients undergoing urologic surgery. The
      study will initially focus on a pre-defined cohort of patients undergoing radical
      prostatectomy. After the predefined study period for the pre-intervention arm, a three-part
      intervention is employed to assess the effect on opioid prescribing and use in the
      post-intervention arm. Pending results, the intervention may be applied to all surgeries in
      the department for routine clinical care.
    

Detailed description: 
      The goal of the study is to reduce the amount of opioid analgesia prescribed after urologic
      surgery in the Department of Urology at Johns Hopkins. The initiative focuses on patients
      undergoing surgery for prostate cancer with radical prostatectomy including patients enrolled
      in IRB00123618/NCT03006562. The pre-intervention arm will consist of patients enrolled August
      2017 to January 2018. The intervention arm will consist of patient enrolled January 2018 to
      completion of the study.

      The intervention consists of a information discharge sheet, a standardized prescribing
      guideline at discharge, and nurses providing improved education for patients at discharge
      about appropriate use of opioid medication, routes for disposal, and potential side effects.
      Data on prescriptions written (amount and type of mediation) and use of opioid and other pain
      medication after surgery will be compared before and after the quality improvement initiative
      is started. Outcomes are assessed via 30-day phone call follow-up with data on perioperative
      outcomes, postoperative medication use, and symptoms already assessed in
      IRB00123618/NCT03006562. At the completion of the pre-intervention arm, providers in the
      urology department are informed about the average and distribution of usage of post-discharge
      opioids. Education and standardized prescribing (allowing for provider judgment) may help
      reduce/personalize the amount of opioids prescribed at discharge to reduce wasted medication
      entering circulation. The initiative may then be expanded to encompass all surgeries in the
      department to reduce opioid prescribing and use for routine clinical care.
    

Intervention name(s): Opioid Reduction Intervention; Current Care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Patient education discharge sheet, nursing education, opioid prescription reduction based on Pre-Intervention data; Current unchanged care provided; unchanged provider prescribing and unchanged education of patients prior to intervention
Intervention MeSH terms: Analgesics, Opioid
Allocation: Non-Randomized
Intervention model: Sequential Assignment
Intervention model description: Pre-Post Study Design with Non-Pharmacologic Intervention
Masking: None (Open Label)
Primary purpose: Prevention