In 2016, the Centers for Disease Control and Prevention (CDC) issued opioid prescribing guidelines that recommended limiting the duration of therapy for acute pain. Research has found that the guidelines have changed opioid prescribing in the emergency department, but less is known about the impact on postoperative opioid prescribing. This study examined the effect of opioid prescribing duration limits in Massachusetts and Connecticut on postoperative prescribing. Dosing duration limits resulted in decreases in postoperative prescription size and days supplied in Massachusetts but not in Connecticut.

… (Millwood) … Health Aff (Millwood) … Since 2013, Medicare’s Hospital-Acquired Condition Reduction Program (HACRP) has …

This retrospective cohort study found that adolescent patients who received opioids for surgical and dental procedures were more likely to develop persistent opioid use if they had family members with long-term opioid use. The study team recommends preoperative screening for long-term opioid use in family members as part of prescribing decision-making for adolescent patients.

This observational study found that when patients were prescribed a higher number of opioid pills following surgery, they self-administered more pills, although most patients did consume all of the pills they received. The authors suggest collecting patient-reported opioid consumption data in order to make opioid prescribing safer.

Various regulatory and policy initiatives are being implemented to encourage more responsible opioid prescribing in the face of the ongoing opioid epidemic. One such federal initiative, implemented by the Drug Enforcement Agency in 2014, was to change hydrocodone to a schedule II agent, which restricted hydrocodone to a 90-day supply that could not be prescribed or refilled by telephone. This study examined the effect of the change on hydrocodone prescribing for patients in Michigan who had undergone elective surgery, using a database that measured opioid prescriptions filled by patients. Implementation of the new regulation was associated with an unexpected increase in the amount of opioids filled initially after surgery. Although prescription refill rates decreased, overall there was no significant difference in the total amount of opioids prescribed within the 30-day postoperative period after the schedule change was implemented. The authors hypothesize that the increased restrictions on hydrocodone prescribing may have resulted in surgeons giving larger initial prescriptions in order to ensure postoperative pain control. The effect of national regulatory initiatives on opioid prescribing remains unclear at present, but recent studies have shown that personalized feedback to prescribers may be effective at improving prescribing.

Opioid misuse is an urgent patient safety issue. Research has found that a significant proportion of adults prescribed opioids in the short term remain on opioid medications chronically, but less is known about postsurgical opioid use among pediatric patients. This study analyzed a large, commercial health care claims database to determine whether children and adolescents prescribed opioids following surgery were more likely to be prescribed opioids 3 to 6 months later, compared to children who did not undergo surgery. Researchers found that postoperative opioid use was associated with persistent opioid use. A related editorial raises questions about the breadth of procedures included and calls for development and implementation of evidence-based pediatric pain management strategies that address the risk for persistent opioid use and misuse.

This pre–post study examined the effect of implementing an evidence-based opioid prescribing guideline following cholecystectomy surgery. After guideline implementation, the average number of opioid pills per prescription declined, but no increase in refill requests occurred. More patients were prescribed nonopioid pain medications after guideline implementation than before. These promising results suggest a path toward reducing the use of these high-risk medications.

The opioid crisis is one of the nation's most pressing patient safety problems. Concern has been raised that overprescribing of opioids may be an unintended consequence of efforts to improve patient satisfaction. However, this Michigan study found no relationship between postoperative opioid prescribing and patient satisfaction scores, indicating that efforts to reduce opioid prescribing may not adversely affect patient satisfaction.

Opioid medication use represents a significant safety problem in the United States. Overprescribing by providers is one factor contributing to the widespread use of opioids. Reducing inappropriate prescribing may help improve patient safety. Using claims data for 36,177 patients, investigators sought to better characterize new and persistent opioid use after surgery, defined as filling an opioid prescription between 90 and 180 days postoperatively. Although there was no major difference in persistent opioid use between those who underwent minor surgical procedures and those who underwent major surgical procedures, results demonstrated that opioid use persisted in greater frequency after surgery among patients with behavioral, pain, and substance use disorders. A recent PSNet perspective discussed patient safety with regard to opioid medications.

Health systems struggle with how to effectively involve patients in safety efforts without placing undue responsibility or blame on them. Greater patient–clinician collaboration is particularly important for error disclosure because of the well-documented gaps in clinician and patient perspectives. In this study, investigators developed an intervention to have patients or family members teach error disclosure and prevention to interprofessional clinician learners, including physicians, nurses, and social workers. Their pre–post evaluation showed that the majority of patient and clinician participants reported improved communication and found the intervention valuable. Patient and clinician participation was voluntary. Although these results show promise for involving patients and families as teachers for error disclosure and prevention training, further work is needed to determine whether this approach will be effective among broader health care teams, as opposed to interested clinicians who volunteer. A related editorial discusses the challenges of including patients in safety efforts.

Duty hour reform was enacted to improve patient safety, but its effect remains unclear. This study found no difference in surgical complication rates before and after implementation of 2011 duty hour reforms, using nonteaching hospitals as a reference population. These results add to the literature suggesting that duty hours had no substantial impact on patient outcomes.

This commentary reviews direct disclosure of radiology errors to patients, barriers to those discussions, and tactics to improve them.

… Journal of the American College of Surgeons … J Am Coll Surg … Do resident physicians contribute …

An electronic system was developed in order to ensure correct assignment of hospitalist physicians to patients at admission and at the time of care transitions (e.g., discharge from the intensive care unit).

… Journal of Patient Safety … J Patient Saf … This study demonstrated that even with an …