The “Opioid Square”: A Novel Educational Tool for Making Opioid Conversions

Abstract

•Determine the degree to which the “Opioid Square” tool assists 2nd year medical students in correctly calculating opioid conversions.•Evaluate the student's preference to use the “Opioid Square” in comparison to the classic equianalgesic tables to calculate opioid conversions. Equianalgesic conversions between opioid drugs and oral and intravenous formulations are a clinically important skill, for all practitioners who treat pain. Accuracy is critical to preventing serious adverse events. Opioid conversion tables are a commonly used tool for teaching this skill, however a needs assessment at our institution reveals the classic conversion table is difficult for learners to understand. A novel visual tool, the “Opioid Square” was developed to provide a different visual framework for opioid conversions. The sample consisted of 200 students at a single academic institution who were learning opioid conversions for the first time during their Pharmacology class. Students were taught conversions using both the standard conversion table, and the “Opioid Square” method. An eight item conversion quiz followed, on various opioid drugs and formulations of each. Students were allowed to use either tool and preferences were assessed with qualitative comments. 187/200 students participated in the study. Accuracy of the eight conversion questions was generally good (85%-100% correct), and without any statistical differences in accuracy between the Square and the Table. Incorrect conversions were more likely on two-step problems (i.e., IV fentanyl to oral morphine). A slight majority of students (53%) indicated that they preferred the “Opioid Square” over the Conversion Table, and 35% noted they would prefer to use both tools if given the option in the future. Providing an alternative visual tool to the classic opioid conversion table was well received by students in this study. Our presentation will include an “Opioid Square” pocket card and explanation of how to use and teach this method in other institutions. The novel “Opioid Square” tool is not inferior to the classic opioid equianalgesic table for helping students make accurate conversions. As many students preferred the “Square,” this tool may provide educators with an alternative visual framework for teaching opioid conversions.