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

Practice Changes and Recommendations

This QI project demonstrated that a discharge opioid prescribing guideline effectively decreased the amount of opioids prescribed after urologic surgery. The decrease in discharge opioid prescribing may have resulted in an increase in the proportion of opioid refill; although a modest rise, it reached statistical significance. Considering the low opioid utilization rate, the favorable self-reported pain control, and the absence of readmission due to acute pain episode, the observed increase in opioid refills likely has negligible clinical significance.

The pre-implementation group's larger sample size and a higher proportion of patients who underwent procedures requiring percutaneous punctures and laparoscopic incisions may explain the difference in the LOS between the pre- and post-implementation groups (see Figure 2). The purpose of the surgery (nephrectomy versus pyeloplasty) may have accounted for the between group difference in the inpatient MME usage among patients who underwent laparoscopic procedures.

Figure 2.

Between-Group Comparison in the Number of Procedures Performed