Change Opioid Prescribing Habits at Your ASC Come to ASCA 2019 to learn how BY RACHEL UZLIK AND GARY WYARD, MD

During the past several decades, the US has experi- enced increas-

ing problems with opioid abuse. To counter the epidemic, we conducted a study to identify internal improvement processes throughout one of the largest orthopedic practices in the US and its affiliated ASCs to promote and drive change in opioid-prescribing patterns in their physicians.

During our presentation, “A Com-

munity Approach to Combating the Opioid Crisis,” at the ASCA 2019 Con- ference & Expo, May 15–18, in Nash- ville, Tennessee, we will share our find- ings from the study that we used to create improvement processes to reduce prescribing habits in our physicians. According to a study published in the January–February 2014 issue of PubMed, the number of opioid pre- scriptions in the US increased by 104 percent between 2000 and 2010, after the American Pain Society (APS) trade- marked pain as the fifth vital sign in 1996. Amongst the opioid prescriptions dispensed throughout all outpatient US retail pharmacies in 2009, orthopedic surgeons accounted for an estimated 7.7 percent, falling behind the main pre- scribers, primary care physicians, who prescribed 28.8 percent and internists who prescribed 14.6 percent. A study published in the March 1, 2019, issue of The Journal of the American Acad- emy of Orthopaedic Surgeons revealed the numbers above.

Our study started in June 2017 and included 115 orthopedic physicians. Our goal was twofold: 1) reduce opioid prescription pill quantities, strength and dose from the baseline assessment by studying specific orthopedic specialty cases and 2) reorganize prescribing


Rachel Uzlik and Gary Wyard, MD, will present “A Com munity Approach to Combating the Opioid Crisis” on Friday, May 17, from 8:00–9:30 am. Learn more and see the complete schedule on the ASCA 2019 website. annualconference/schedule

habits by physicians to provide safe and efficient quality care to their patients. A small group of physicians within

the organization hypothesized this proj- ect after questioning the current state of pain management, including the quan- tity and specific type of opioids being prescribed. After unanimous board approval, the current processes through- out the entire organization were evalu- ated examining morphine equivalent units (MEU) and total number of pills prescribed by procedure that were com- mon in their affiliated outpatient ASCs. Common procedures were selected based on 14 or more cases in the data set. Our baseline assessment established

the existing state of opioid prescrip- tions. We followed this assessment with three separate improvement phases aimed at improving the organization’s

Habits that lead to the over-prescribing of opioids will continue to be problematic until physicians and organizations alter their systems.”

— Rachel Uzlik and Gary Wyard, MD

overall opioid prescribing habits. Our physicians reported the average opioids they prescribed to manage patient pain and gain satisfaction for elective outpa- tient orthopedic surgeries. We collected data on the type, dosage and quantity of prescribed opioids after outpatient pro- cedures, as well as patient interviews within two weeks after surgery. Then we compared average prescribing hab- its within designated periods of time. The comprehensive analysis of this project resulted in (1) identifying the current state of opioid prescribing hab- its throughout the organization, (2) identifying areas of improvement, (3) implementing change in those areas, and (4) realizing an overall decrease in prescribed opioids.

Habits that lead to the over-pre- scribing of opioids will continue to be problematic until physicians and orga- nizations alter their systems. During a 15-month time frame, this single private orthopedic practice set a goal of reduc- ing prescribing habits to satisfy the Cen- ters for Disease Control and Prevention (CDC) guidelines that specify MEU dosages no greater than 50 MEU per day for up to three days. Through the imple- mentation and successful execution of baseline and three phases, the organiza- tion achieved the CDC guideline param- eters and an average reduction in the MEUs prescribed of 62.3 percent. We will share more at ASCA 2019 and answer any questions that you have about how to reduce prescribing habits at your ASC.

Rachel Uzlik is the vice president of clinic service at Twin Cities Orthopedics in Golden Valley, Minnesota, and vice president of quality at Revo Health also in Golden Valley; Gary Wyard, MD, is the chief medical officer at Twin Cities Orthopedics. Write them at racheluzlik@ and

ASC FOCUS MAY 2019 | 9

Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38