Quality Improvement Project: Discharge Opioid Prescribing Guideline for the Urologic Surgery Patient Population

Christopher Acebedo, DNP, ACNP-BC, CCRN; Nancy Hung, PharmD; Cameron Heshmati


Urol Nurs. 2020;40(1):23-30. 

In This Article


The QI project was designed using the four over-arching findings described in the literature: 1) over-prescription exists among specialty surgery patient populations, 2) population- and procedure-specific opioid prescribing guidelines decrease over-prescription of opioid agents at the time of discharge, 3) PDMP utilization is effective in decreasing opioid over-prescription, and 4) a multimodal approach is an essential element of an opioid-prescribing guideline. A senior acute care nurse practitioner and a senior specialty surgery clinical pharmacist spear-headed this project.

Inclusion criteria were patients age 18 years and older admitted to the inpatient urology service from May to December 2017 (retrospective analysis) compared to post-guideline implementation patients admitted from March to May 2019 (prospective data collection and patient survey administration). Exclusion criteria were prescription of patient-controlled analgesia, either through epidural or intravenous administration at any point during admission; prescription of long-acting opioid before admission; patients who were admitted to the intensive care unit; patients who underwent open abdominal procedures; and patients who were ordered acute or chronic pain service consultation.