Opioid risk screening in gynecologic oncology patients: A pilot study

Abstract

Objectives: Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in gynecologic oncology surgical patients. It is, therefore, imperative to follow guidelines for perioperative prevention. Many centers use neuraxial analgesia (NA), a practice that may affect the timing of prophylactic anticoagulant administration. In 2013, compliance with preoperative anticoagulant administration at our institution was noted to be 41% in NA patients undergoing laparotomy. We undertook a quality initiative (QI) aimed at increasing compliance. Methods: A multidisciplinary working group comprising stakeholders in the surgical pathway was formed with the goal of increasing compliance to at least 80% in NA cases and maintaining a minimum of 90% in non-NA cases. Compliance was defined as receipt of a prophylactic dose of anticoagulant within 1 h after NA or before skin incision regardless of anesthesia type. Following discovery, design, and trial implementation phases, a QI intervention bundle was deployed that included targeted education sessions, specific perioperative physician order tools, and improved documentation of anticoagulant administration. Institutional review board approval was obtained and retrospective data collection performed between 7/1/14 and 9/4/14 for interim analysis. Those having surgery in the year before the QI were used for comparison. The primary outcomewas rate of compliance. The secondary outcome was timing of anticoagulation. Student's t-test and Fisher's Exact were used. Results: There were 36 women treated under the QI and 182 historical cases (HC). Fifty percent of QI cases (n = 18) had NA compared with 34% of HC (n = 63), P= 0.09. Overall compliance improved, with 94% QI vs. 73% HC, P= 0.004. This difference was marked in cases with NA (94% QI vs. 40% HC, P b 0.001). Compliance remained stable in non-NA cases (94% QI vs. 91% HC, P = 1.0). The mean number of minutes between drug administration and skin incision was −55 (standard deviation [SD] 61) in QI cases compared with −19 (SD 52) in HC cases and this difference was significant P = 0.0024. Conclusions: Relatively simple quality initiatives aimed at improving routine processes within the surgical pathway are feasible and attract participation from staff. Such ongoing efforts are likely to translate into higher levels of patient safety and greater workplace satisfaction.