Opioid Disposal Research Articles

Promoting Disposal of Left-Over Opioids After Surgery in Rural Communities: A Qualitative Description Study.

Patients rarely dispose of left-over opioids after surgery. Disposal serves as a primary prevention against misuse, overdose, and diversion. However, current interventions promoting disposal have mixed efficacy. Increasing disposal in rural communities could prevent or reduce the harms caused by prescription opioids. Identify barriers and facilitators to disposal in the rural communities of the United States Mountain West region. We conducted a qualitative description study with 30 participants from Arizona, Idaho, Montana, Nevada, Oregon, Utah, and Wyoming. We used a phronetic iterative approach combining inductive content and thematic analysis with deductive interpretation through the Precaution Adoption Process Model (PAPM). We identified four broad themes: (a) awareness, engagement, and education; (b) low perceived risk associated with nondisposal; (c) deciding to keep left-over opioids for future use; and (d) converting decisions into action. Most participants were aware of the importance of disposal but perceived the risks of nondisposal as low. Participants kept opioids for future use due to uncertainty about their recovery and future treatments, breakdowns in the patient-provider relationship, chronic illness or pain, or potential future injury. The rural context, particularly convenience, cost, and environmental contamination, contributes to decisional burden. We identified PAPM stage-specific barriers to disposal of left-over opioids. Future interventions should account for where patients are along the spectrum of deciding to dispose or not dispose as well as promoting harm-reduction strategies for those who choose not to dispose.

Using an Environmentally Friendly Disposal Bag to Discard Leftover Opioids After Gynecologic Surgery.

To evaluate the effects of an environmentally friendly drug deactivation bag on opioid disposal among patients undergoing gynecologic surgery. This prospective cohort study included patients undergoing gynecologic procedures requiring an opioid prescription from March 2020 to December 2020. Patients were managed on a restrictive opioid prescribing algorithm and given an opioid disposal bag. The carbon drug deactivation bag neutralizes the opioid medication and can be discarded safely in the trash. Patients were educated about pain management goals and the disposal bag. Patients were surveyed at their postoperative visit to evaluate satisfaction, number of leftover pills, and disposal methods. Statistical analysis was performed using SPSS Statistics 26. Two hundred patients were asked to complete the survey, with a response rate of 78%. The most common procedures were exploratory laparotomy (50%) and minimally invasive hysterectomy (41%). Most patients (91%, 95% CI 91-97) filled their opioid prescription and 64 (41%, 95% CI 34-48) had leftover opioid pills. Most patients with leftover opioid pills (73%, 95% CI 67-79) discarded them; 78%, 95% CI 69-80 used the disposal bag. Patients undergoing an exploratory laparotomy most commonly used the disposal bag. All patients who used the disposal bag stated they would use it again. Despite a restrictive opioid prescribing algorithm, 41% of gynecologic surgical patients had leftover opioid pills. This study demonstrated that leftover opioid pills were safely discarded 73% of the time when patients were provided an opioid disposal bag and preoperative education.

Improving Opioid Stewardship in Pediatric Emergency Medicine

Poor opioid stewardship contributes to opioid misuse and adverse health outcomes. We sought to decrease opioid prescriptions in children 0 to 18 years treated for pain after fractures and cutaneous abscess drainage from 13.5% to 8%. Our secondary aims were to reduce opioid prescriptions written for >3 days from 41% to 10%, eliminate codeine prescriptions, increase safe opioid storage and disposal discharge instructions from 0% to 70%, and enroll all emergency department (ED) physicians in the state prescription drug monitoring program. We implemented an intervention bundle on the basis of 4 key drivers at a pediatric ED: ED-wide education, changes in the electronic medical record, discharge resources, and process standardization. Two plan-do-study-act cycles were performed. Interventions included provider feedback on prescribing, safe opioid storage and disposal instructions, and streamlined electronic medical record functions. Run charts were used to analyze the effect of interventions on outcomes. Our balance measure was return ED or clinic visits for inadequate analgesia within 3 days. During the intervention period, 249 of 3402 (7.3%) patients with fractures and cutaneous abscesses were prescribed opioids. The percentage of opioid prescriptions >3 days decreased from 41% to 13.2% (P < .0001), codeine prescription dropped from 1.1% to 0% (P = .09), opioid discharge instructions increased 0% to 100% (P < .0001), and all physicians enrolled in the prescription drug monitoring program. There was no change in return visits for uncontrolled analgesia compared with the baseline (P = .79). A comprehensive opioid stewardship program can improve opioid prescribing practices of ED physicians and deliver information on safe storage and disposal of prescription opioids with a negligible effect on return visits for uncontrolled pain.

Opioid Prescribing and Utilization Following Isolated Mid-Urethral Sling.

Introduction: Overprescribing by providers is a leading contributor to the opioid crisis. Despite available information regarding the role that physician prescribing plays in the community availability of opioids, guidelines for the management of acute pain remain sparse. This project aims to evaluate opioid prescribing, opioid usage patterns, and postoperative pain control in patients undergoing isolated mid-urethral sling (MUS) placement.Methods: Patients who underwent isolated MUS placement from March 19, 2019 through March 19, 2020 were contacted by telephone in May 2020 and asked a series of questions examining opioid usage, postoperative pain, what they did with unused opioids, and whether they had received education on disposal techniques. A chart review was utilized to determine the amount of opioid prescribed, the presence of any operative complications, and medical and demographic characteristics of subjects.Results: A total of 53 subjects met inclusion criteria, of which 31 participated in a phone interview. Of the 53 subjects, 54.7% received a postoperative opioid prescription, and all but two of these subjects filled their prescription. Of the interviewed subjects, only 66.6% who filled a prescription reported using opioids Fifty percent (n=6) of patients that required oxycodone reported use of four tablets (30 morphine milligram equivalents (MMEs)) or less and used for 1-2 days postoperatively. No patient reported using opioids beyond five days. Only 22.2% reported receiving instruction on opioid disposal, and 16.7% returned unused opioids to a disposal center. 87.1% of subjects rated postoperative pain as “better” or “much better” than expected.Conclusion: Patients undergoing isolated MUS placement require limited amounts of postoperative opioids, if any are needed at all, to achieve satisfactory pain control. Excess prescribed opioids, along with inadequate patient education on proper disposal techniques, may contribute towards opioids that are at risk of diversion for nonmedical use.

A safe in-home disposal system with every opioid prescription? Food and Drug Administration is considering a potential new Risk Evaluation and Mitigation Strategy that could impact pharmacists

Misuse of prescription opioids contributes to the ongoing crisis of opioid-related overdose and deaths in the United States. The failure of patients and caregivers to safely dispose of unused opioids contributes to the problems. In 2018, Public Law 115-271 provided U.S. Food and Drug Administration (FDA) authority to mandate a Risk Evaluation and Mitigation Strategy (REMS) for safe disposal packaging or safe disposal solutions for opioid analgesic medications. FDA has been collaborating with stakeholders to determine whether a new REMS is needed. A new or revised opioid REMS could substantially affect opioid packaging, pharmacist roles and services, and dispensing activities such as education, counseling, and product distribution. The pharmacy profession has provided limited input to FDA regarding a potential new or revised opioid REMS. In this commentary, we aim to (1) provide awareness and raise questions on pertinent issues regarding opioid use and safe home disposal, (2) offer considerations for regulators on needed research in the development and assessment of a new REMS, and (3) highlight actions for pharmacist engagement in patient care services to promote safe use and safe home disposal of opioids. Consideration of a potential mandate regarding enhanced safety packaging or safe disposal solutions for opioids presents opportunities to revisit professional roles and engage proactively with FDA and other stakeholders. We hope this commentary stimulates timely feedback by pharmacy leaders, researchers, and practitioners on whether and how options for safe home disposal of opioids should be included in a REMS in contemplation of potential benefits, unintended consequences, expanded professional roles, timeline, assessment of program effectiveness, and adequate compensation. We support a shared opioid REMS that funds the counseling of patients and caregivers on safe opioid use and safe home opioid disposal options and provides appropriate education and products to facilitate that disposal.

Expectation-setting and patient education about pain control in the perioperative setting: A qualitative study.

Interventions aimed at limiting opioid use are widespread. These are most often targeted toward prescribers or health systems. Patients' perspectives are too often absent during the creation of such interventions. This qualitative study aims to understand patient experiences with education about perioperative pain control, from preoperative expectation-setting to post-operative pain control strategies and ultimately opioid disposal. We performed semistructured interviews focused on patient experiences in the perioperative period. Content from interview transcripts was analyzed using a constant comparative method. All participants underwent surgery at a single, academic tertiary-care center. Adult patients who had a general surgery operation in the prior 60 days. Key themes from interviews about perioperative pain management, specifically related to preoperative expectation-setting and post-operative education. Patients identified gaps in communication and education in three main areas: preoperative expectation setting of post-operative pain; post-operative pain control strategies, including use of opioid medications; and the importance of appropriate opioid disposal. Failure to set expectations led to either significant patient anxiety preoperatively or poor preparation for home discharge. Poor education on pain control strategies led to misinformation on when and how to use opioids. Lack of education on opioid disposal led to most participants failing to properly dispose of leftover medication. Gaps in education surrounding post-operative pain and opioid use can lead to patient anxiety, inappropriate use of opioids, and poor disposal rates of leftover medications. Future interventions aimed at patient education to improve pain management and opioid stewardship should be created with an understanding of patient experiences and perceptions.

The Impact of Proper Opioid Disposal Education.

Every day, more than 190 people in the United States die from opioid overdose. Unused opioid medications pose a risk to the patient and the community as they increase the potential for abuse or misuse. A contributing factor is lack of education on the proper disposal methods of unused opioid medications. The purpose of this quasi-experimental nursing study was to examine whether providing education on proper disposal of opioid medications would increase the proportion of patients who properly dispose of unused opioids. The study site's mandatory orthopaedic preoperative class was used for consenting patients. The control group did not receive targeted education on opioid disposal, whereas the intervention group did receive targeted education. A total of 86 patients were consented during Months 1 and 2 of the study. Forty-one patients were in the control group and 45 were in the intervention group. Demographic variables such as age, gender, and marital status were collected to determine whether certain demographic factors had an influence over whether or not opioids would be disposed of properly. Those in the intervention group who attended the class were slightly younger than those in the control group (68.2 ± 9.9 years vs. 70.3 ± 10.6 years, p = .5098), primarily male (57.5% vs. 35.0%, p = .0436), and more likely to live with a significant other (94.7% vs. 74.4%, p = .0249). Of those who had medication left over, 62.5% disposed of their unused opioid prescription in the intervention group compared with 40.7% in the control group (p = .1208). In the intervention group, 86.7% of the individuals with leftover medication disposed of it correctly compared with 63.5% in the control group (p = .3478). Those who received education on appropriate opioid disposal were more likely to dispose of it in general as well as dispose of it correctly. Although not statistically significant, the findings from this study are clinically significant in that they provide direction on the importance of standardized and focused patient education on proper opioid disposal.

Opioid reduction and elimination in pediatric surgical patients

Opioid overuse is a national concern. Mitigation strategies include judicious prescribing and encouragement of non-opioid therapies. This quality improvement project aimed to identify physician opioid prescribing and patient usage patterns at a pediatric academic center. Patients who underwent same-day general, orthopedic, or plastic surgery procedures were contacted 7 - 28 days post-operatively. Inquiries were made about opioid usage, non-opioid strategies, and overall pain management satisfaction. A subset of general surgery patients not prescribed opioids was compared to those prescribed opioids. Between August 2017 - May 2020, 558 surveys were obtained. There was a significant increase in the use of non-opioid therapies between 2017 and 2020 (83.5% vs 97%, p=0.04). Almost all patients' opioid prescriptions were filled; however, 78-98% had leftover opioids. Only 20-25% disposed the excess opioids. In subset analysis of general surgery patients, no inguinal hernia or orchiopexy patient who was discharged without opioids required opioids later. More non-opioid patients used other therapies (acetaminophen, heat (p=0.03)); however, pain management satisfaction was higher in the opioid group (99% vs 94%, p=0.01). While our opioid prescribing has decreased, physicians are still prescribing more opioids than patients require. Further education on non-opioid pain therapies and proper disposal of opioids are needed. III TYPE OF STUDY: prospective quality improvement study.

Use of An Opioid Disposal Bag for Leftover Pills in Gynecologic Oncology Patients Undergoing Surgery

Use of An Opioid Disposal Bag for Leftover Pills in Gynecologic Oncology Patients Undergoing Surgery

Efficacy of a password-protected pill-dispensing device to enhance disposal of unused opioids after cancer surgery.

264 Background: Opioid misuse is a public health crisis. Initial opioid exposures often occur post-operatively, and 10% of opioid-naïve patients who undergo cancer surgery subsequently become long-term opioid users. It has been shown that 70% of opioids prescribed post-operatively go unused, but only 9% of unused pills are disposed appropriately, which increases the risk of unintended use. We evaluated the impact of an inexpensive, password-protected dispensing device with mail return capacity on retrieval of unused pills after cancer surgery. Methods: Adult patients scheduled for major cancer-related surgery were eligible. Enrolled patients received opioid prescriptions in a password-protected, pill-dispensing device (Addinex) from a specialty pharmacy. The mechanical device links to a smartphone app, which provides passwords on a prescriber-defined schedule. Patients request a password when they are in pain, enter the password into the device and receive a pill if the prescribed time has elapsed. The smartphone app provides clinical guidance based on patient-reported pain levels, and suggests tapering strategies. Patients are instructed to return the device in a DEA-approved mailer when opioid use is no longer required for pain control. Unused pills are destroyed upon receipt. The primary objective was to determine the feasibility of device return, defined as &gt; 50% of patients with device return. We also explored patterns of device use, patient reported outcomes, and device satisfaction via surveys and semi-structured interviews. Results: Between October, 2020 and April, 2021, 13 patients completed the study; 4 patients are currently enrolled. Among the initial 13 patients, 7 underwent abdominal hysterectomy, 4 underwent mastectomy and 2 underwent cutaneous tumor resections. The majority of these patients (n = 10, 77%) returned the device, and more than half (n = 7, 54%) returned the device within 6 weeks of surgery. Only a minority of patients (n = 5, 38%) used the device to obtain opioids; most (n = 8, 62%) used no opioids at home, and all of these patients returned the device and the unused pills. Of 11 patients who participated in semi-structured interviews, most (n = 7, 64%) said they felt safer having opioids in the device instead of a regular pill bottle. Among device users, the majority (n = 4, 80%) reported an overall positive experience. All non-users reported having no opioid requirement for pain control. Conclusions: Our early findings suggest that use of an inexpensive, password-protected, pill-dispensing device to assist with opioid dispensing and return is feasible, with a high rate of device and unused opioid return to the pharmacy. This strategy may be effective for reducing opioid diversion. Analyses and recruitment are ongoing to evaluate the benefits of reducing post-operative opioid consumption.

Opioid disposal rates after spine surgery.

Background: Diversion of prescription opioids pills is a significant contributor to opioid misuse and the opioid epidemic. The goal of this study was to determine the frequency and quantity of excess opioid pills among patients undergoing spine surgery. Further, we wanted to determine the frequency of appropriate opioid disposal.Methods: This was a prospective cohort study of patients undergoing elective spine surgery within a multi-hospital, academic, urban university health system enrolled in a text-messaging program used to track postoperative opioid disposal. Patients who self-reported discontinuation of opioid use but with leftover pills were contacted via telephone and surveyed on opioid disposal.Results: Of the 291 patients who enrolled in the text-messaging program, 192 (66%) patients reported discontinuing opioids within 3 months of surgery. Although 76 (40%) reported excess opioid pills after cessation of use, only 47 (62%) participated in the telephone survey regarding opioid disposal. The median number of leftover pills among these 47 patients was 5 (5, 15) and 64% had not disposed of their prescription.Conclusion: Among the 47 telephone survey participants, a persistent gap remained in postoperative opioid excess and improper disposal. Future efforts must focus on initiatives to improve opioid disposal rates to reduce the quantity of opioids at risk for diversion and to reduce excess prescribing.

A Prospective Assessment of Opioid Utilization Post-Operatively in Orthopaedic Sports Medicine Surgeries.

The healthcare system is plagued finding the balance between opioid use and abuse. Orthopaedic surgeons are expected to curtail the number of opioids prescribed in order to lower opioid abuse. We sought to prospectively evaluate opioid consumption following a wide range of sports orthopaedic surgical procedures to determine utilization patterns. All patients receiving procedures within a one-year period were consented and then called daily for one week followed by weekly for up to two months or until the patients no longer were taking their opioid medication. We studied the number of opioids patient's took postoperatively and also collected information in regards to the patient and the surgical procedure. Included were 223 patients with a mean age of 32.9 years (range, 11 to 82). Surgeons prescribed a mean total of 59.5 pills, and patients reported consuming a mean total of 20.9 pills, resulting in a utilization rate of 40%. 94.4% of patients received no education on how to properly dispose of unused opioids. The mean SANE score was 53.9. The mean Pain Catastrophizing Scale score was 15.1. The mean Opioid Risk Tool was 3.3. The procedures were broken down into: 47.5% ligamentous knee repair, 18.4% shoulder arthroscopy/other shoulder, 7.6% meniscus, 7.6% shoulder arthroplasty, 5.4% distal biceps, 4.0% lower leg (ankle/foot/tibia) and 4.0% shoulder ORIF. Over-prescribing opioids after sports orthopaedic surgeries is widespread. In this study, we found that patients are being prescribed 2.48 times greater opioid medications than needed following sports orthopaedic surgical procedures. We recommend surgeons take care when prescribing postoperative pain control and consider customizing their opioid prescriptions on the basis of prior opioid usage, anatomic location and procedure type. We also recommend educating the patients on proper disposal of excess opioids and consider involving pain management for patients likely to require prolonged opioid usage.

What's New in Pain Management for Pediatric Orthopaedic Surgery.

Improving pain control and decreasing opioid prescription and usage continue to be emphasized across both pediatric and adult populations. The purpose of this review is to provide a comprehensive assessment of recent literature and highlight new advancements pertaining to pain control in pediatric orthopaedic surgery. An electronic search of the PubMed database was performed for keywords relating to perioperative pain management of pediatric orthopaedic surgery. Search results were filtered by publication date for articles published between January 1, 2015 and December 1, 2020 and yielded 404 papers. A total of 32 papers were selected for review based upon new findings and significant contributions in the following categories: risk factors for increased opioid usage, opioid overprescribing and disposal, nonpharmacologic interventions, nonsteroidal anti-inflammatory drugs, peripheral nerve blocks, spine surgery specific considerations, surgical pathway modifications, and future directions. There have been many advances in pain management for pediatric patients following orthopaedic surgery. Rapid recovery surgical care pathways are associated with shorter length of stay and improved pain control in pediatric spine surgery. Opioid overprescribing continues to be common and information regarding safe opioid disposal practices should be routinely provided for pediatric patients undergoing surgery. Level IV-literature review.

The potential for diversion of prescribed opioids among orthopaedic patients: Results of an anonymous patient survey.

Diversion of prescription opioid medication is a contributor to the opioid epidemic. Safe handling practices can reduce the risk of diversion. We aimed to understand: 1) if orthopaedic patients received instructions on how to safely handle opioids, 2) their typical storage/disposal practices, and 3) their willingness to participate in an opioid disposal program (ODP). Cross-sectional study of adult orthopaedic patients who completed an anonymous survey on current or past prescription opioid use, instruction on handling, storage and disposal practices, presence of children in the household, and willingness to participate in an ODP. Frequencies and percentages of responses were computed, both overall and stratified by possession of unused opioids. 569 respondents who reported either current or past prescription opioid use were analyzed. 44% reported receiving storage instructions and 56% reported receiving disposal instructions from a health care provider. Many respondents indicated unsafe handling practices: possessing unused opioids (34%), using unsafe storage methods (90%), and using unsafe disposal methods (34%). Respondents with unused opioids were less likely to report receiving handling instructions or using safe handling methods, and 47% of this group reported having minors or young adults in the household. Respondents who received storage and disposal instructions were more likely to report safe storage and disposal methods. Seventy-four percent of respondents reported that they would participate in an ODP. While many orthopaedic patients report inadequate education on safe opioid handling and using unsafe handling practices, findings suggest targeted education is associated with better behaviours. However, patients are willing to safely dispose of unused medication if provided a convenient option. These findings suggest a need to address patient knowledge and behavior regarding opioid handling to reduce the risk of opioid diversion.

Practitioner counseling associated with improved opioid disposal among families of postoperative pediatric patients

Death from opioid-related overdose has doubled in recent years. Interestingly, there has been a similar increase in the number of opioid prescriptions. Medical providers, unfortunately, have contributed towards this rise in prescriptions. To combat the opioid epidemic, numerous efforts have been made to focus on the medical field and its role in the opioid epidemic. Proposed solutions for reduction of circulating opioids have included such measures as education, monitoring programs, alternative pain management strategies, and improved opioid disposal. We aimed to assess if counseling is associated with proper opioid disposal among families of post-operative pediatric patients. We conducted a cross-sectional, convenience sample study of families of post-surgical, pediatric patients at a single academic institution. Participants completed a survey during their postoperative visit assessing opioid requirements, storage and disposal during and after the postoperative period, and if they were counseled by any medical professional on proper disposal methods. We used multivariable logistic regression to evaluate the association between the independent variables and the primary outcome. We enrolled 180 participants, mean age of 8 years. Thirty-four percent reported having no opioid medication remaining at follow up because the medication was either consumed or the prescription was not filled. Sixty-six percent had leftover medication at the time of follow up. Sixty-six percent of participants knew the proper opioid disposal methods. However, only 22% of patients with leftover medication properly disposed of the medication. Patients who were counseled about proper opioid disposal were 3 times more likely to practice proper disposal practices than those who were not (p<0.01). Our study uniquely look at opioid consumption, disposal rates, and the effect of counseling in a diverse post-surgical pediatric population. Our findings confirm similar observations in the literature with regards to low opioid consumption, but in a larger, more surgically diverse cohort with a 100% response rate. Limitations included a lack of demographic diversity and lack of data measuring the impact of timing or frequency of counseling on opioid disposal practices. Further research goals would be to evaluate the effectiveness of counseling on proper opioid disposal, and the influence of timing and various counseling methods. Most patients do not use all of their opioid medication prescription. Proper opioid disposal counseling by a medical professional may play an important role in adherence to recommended opioid disposal practices.

Implementation of Strategies to Reduce Improper Disposal of Opioids Following Orthopedic Surgery: A Pilot Study

<h3>Introduction</h3> The opioid epidemic remains a challenging problem currently facing healthcare systems. As opioids are often prescribed in greater quantities than patients consume, proper disposal of unused medications is crucial. <h3>Identification of the problem</h3> Literature suggests many patients who are prescribed opioids share medications with another person and that there is a lack of patient education regarding safe disposal of opioids. <h3>Purpose of the Study</h3> To analyze how the implementation of the Deterra® Disposal Pouch (DDP), and education regarding its use, may reduce the percentage of improper disposals of opioids following orthopedic surgery. Secondly, the study examined the patient utilization rate of the DDP after implementation. <h3>Methodology</h3> All patients undergoing elective orthopedic surgery at a single ambulatory surgery center noted their opioid disposal technique via an automated survey 2-weeks post-operatively. Pre-implementation (12/2018-02/2019) versus post-implementation (12/2019-02/2020) of the DDP were compared for improper disposal (storing prescription, flushing down the toilet, etc.) versus proper disposal (DDP, dropped at police station/pharmacy/city-hall, etc.). Patients not prescribed opioids, still taking opioids, or who had finished their opioid prescription at the time of the survey were excluded. <h3>Results</h3> Prior to implementation of the DDP, 54.2% (n=39) of patients disposed of their opioids improperly versus 45.8% (n=33) properly. Following implementation, 49.1% (n=53) disposed of their opioids improperly versus 50.9% (n=55) properly. Importantly, post-implementation, 21.3% (n=23) of patients disposed of their opioids using the DDP. This difference between 54.2% and 49.1% was not statistically significant, yet may be deemed clinically relevant (p=.502). <h3>Discussion</h3> The results suggest the effectiveness of implementing strategies to encourage proper disposal of unused opioids following orthopedic surgery, with important implications for reducing the negative, secondary effects of improperly storing and disposing of opioids. <h3>Conclusion</h3> Comprehensive implementation and education regarding proper use of the DDP led to decreases in improper opioid disposal, with over 1 in 5 patients utilizing the new disposal method. <h3>Implications for perianesthesia nurses and future research</h3> Perianesthesia nurses play an important role in educating patients about correct use and reasoning behind proper disposal of opioids. The authors recognize this data is preliminary, but further large-scale studies are warranted to study effective opioid disposal.

Leveraging Community Partnerships and Education to Improve the Safe Use, Storage and Disposal of Opioids

<h3>Introduction</h3> Literature suggests patients often have leftover opioids after surgery. It has also been reported that opioids are frequently not stored in a safe place at home. With the assistance of a community program, this hospital system received a donation of items to safely store and/or dispose of opioids to give to patients being discharged with an opioid prescription. <h3>Identification of the problem</h3> Utilizing the Instrument developed by Odem-Forren (Odom-Forren, Brady, Rayens, & Sloan, 2019), nurses were assessed for their knowledge and practice on safe opioids use, storage and disposal education. Gaps were identified across a community based hospital system with four hospitals and two outpatient surgery centers. <h3>EBP Question/Purpose: PICO question. Databases utilized</h3> For Perianesthesia nurses, will education and the availability of disposal and storage of opioid options for patients over standard of care, improve discharge teaching practice of safe use, storage and disposal of opioids and patient satisfaction scores? <h3>Methods/Evidence</h3> Education is key to increasing the patient's likelihood of disposal of opioids. To ensure proper education is being provided, nurses need to be knowledgeable about misuse of opioids in the community and the importance of storing or disposing of opioids safely. Champions were identified at each hospital in the system to ensure adoption. Disposal and storage items were compiled and "DASH" (Disposal And Storage at Home) bins were created for each unit that discharges outpatient surgery patients. The education plan was developed based on gaps in knowledge and practice from survey. Education is currently in progress with post-survey to follow. <h3>Significance of Findings/Outcomes</h3> Monitoring for improved patient satisfaction scores, increase in documentation of education, disposal and storage items given and improved post implementation survey results will occur. Results will be analyzed in December 2020. <h3>Implications for perianesthesia nurses and future research</h3> Perianesthesia nurses play a critical role educating patients. Because of this, it is crucial we as nurses are knowledgeable and aware of the safe use, storage and disposal practices that are recommended. Being able to supply patients with the needed items to safely store and dispose of opioids is an added benefit that should be considered whenever possible.

Perianesthesia Nurses’ Knowledge, Attitude, and Intention to Promote Safe Use, Storage, and Disposal of Opioids

<h3>Introduction</h3> Opioid overdose deaths and opioid use disorders are a crisis in the United States. Perianesthesia nurses have an excellent opportunity to educate patients and families who are discharged to home after surgery. <h3>Identification of the problem</h3> In a prior study, the authors found that nurses and other providers do not routinely discuss safe use, storage, or disposal of medications; perianesthesia nurses are more likely to discuss side effects of opioids. <h3>Purpose of the Study</h3> The purpose of this study is to determine if a web-based educational intervention increases knowledge, attitude, and intention of perianesthesia nurses to promote safe use, storage and disposal of opioids. <h3>Methodology</h3> A one group pre-test, post-test interventional study was conducted using a survey of ASPAN nurses. The intervention was a web-based voiceover module with patient education scenarios focused on information for patients before discharge. Responses to the pre-survey and 2 post surveys were collected. Data analysis included descriptive summary and evaluation of changes in knowledge and domains of Theory of Planned Behavior using repeated measures mixed modeling. <h3>Results</h3> The participants included pre-test survey (n = 678), the immediate post-test (n = 247), and the 4-week post-test (n = 171). The analysis presented is limited to 247 who completed at least the first post-survey. For all outcomes, there was an immediate increase in the measure following the intervention; this pairwise difference (between pretest and the immediate post-test) was significant in each model. The immediate and 4-week post-test scores exceeded the corresponding pre-test score, though for perceived behavioral control, attitude, and intention, the difference between baseline and week 4 was not significant. <h3>Discussion</h3> These findings suggest a more intensive intervention with possibly the inclusion of booster sessions, particularly for the outcomes of perceived behavioral control and subjective norms may be needed. <h3>Conclusion</h3> This educational intervention can be implemented at the national level for optimum impact. <h3>Implications for perianesthesia nurses and future research</h3> Perianesthesia nurses are well-positioned to teach patients about the risks of diversion, nonmedical use, and proper disposal of opioids. Research to develop safe postdischarge prescription practices and encourage safe opioid practices after surgery is needed.

Use of an opioid disposal bag for leftover pills in gynecologic oncology patients undergoing surgery

Objectives: To evaluate the effects of an environmentally-friendly drug deactivation bag on opioid disposal in gynecologic oncology patients undergoing surgery. Methods: This descriptive study included gynecology oncology patients undergoing any surgical procedure requiring an opioid prescription from 3/2020-9/2020. Patients were managed on a restrictive opioid prescribing algorithm (ROPA) and given an opioid disposal bag at their preoperative visit. The carbon drug deactivation bag used neutralizes the opioid medication and is environmentally friendly making it disposable in the trash. Patients were educated preoperatively about pain management goals, the disposal bag, and the ROPA. Patients were asked to complete a survey at their postoperative visit evaluating patient satisfaction, number of leftover pills, and disposal methods. Statistical analysis was performed using SPSS Statistics v.25. Results: 140 patients were asked to complete the survey. The response rate was 78.5% (110 patients). The most common procedures were exploratory laparotomy (36.3%) and laparoscopic hysterectomy (32.7%). Ovarian and endometrial cancer were the most frequent diagnoses (17.2% and 27.3%, respectively). 91.8% of patients filled their opioid prescription and 47 (42.7%) had leftover pain medications. 55.3% of patients with leftover medications used the deactivation bag to dispose of them, 12.8% flushed or threw them away, and 31.9% did not dispose of them. Leftover opioid pill amounts included: Conclusions: Despite a restrictive opioid prescribing practice, 40% of patients had leftover opioids. Over half of these patients used the opioid disposal bag to discard their leftover pills. The disposal bag was most commonly used by patients undergoing exploratory laparotomy given the larger number of opioid pills prescribed at discharge. The use of a drug deactivation bag is unlikely to be beneficial in patients undergoing minor outpatient surgery.

Development and validation of the Gynecologic Oncology Predictor Of Postoperative opioid use (GO-POP) model

<h3>Objectives:</h3> With increasing use of minimally invasive surgical techniques and same-day discharges, the need to predict pain medication use on the day of surgery is critical to post-operative pain control, patient satisfaction and public health concerns. Our goal was to develop and externally validate a statistical model for predicting postoperative opioid use following gynecologic surgery in an increasingly minimally invasive surgical population, incorporating patient-reported surgical concerns. <h3>Methods:</h3> We prospectively enrolled 382 women scheduled for abdominal surgeries (including laparotomies and minimally invasive approaches [MIS]) in an academic gynecologic-oncology practice to a study to develop and validate a predictor of outpatient opioid pill use. Negative binomial, zero-inflated negative binomial, and ordinal regression models were developed using an initial cohort of 216 women enrolled from February 2018-March 2019 and followed for 6 weeks postoperatively. A total of 39 candidate predictors were considered, including preoperative assessments of anxiety and anticipated pain as well as intra-operative factors. The primary model outcome was the number of opioid pills used postoperatively. After fitting models using best predictors, all models were internally validated with 1000 bootstrap samples to obtain bias-corrected accuracy using ordinal concordance index and calibration curves. All models' predictions were then externally validated using a second cohort (n=166) enrolled from May 2019-February 2020. The best model (GO-POP) was updated by combining cohorts and an online calculator and nomogram were created. GO-POP included 7 predictors: age, total operating time, patient's self-reported pre-operative anticipated need for pain medication, whether pregabalin was administered preoperatively, patient educational attainment, smoking history and patients' self-reported preoperative anxiety. <h3>Results:</h3> Most surgeries were performed using MIS approaches (276; 72.3%) while 52 (13.6%) patients underwent planned laparotomies and 14.1% had planned MIS approaches converted to laparotomies. Median total number of opioid pills was 7 in the combined cohort. Nearly 40% of subjects used 0 pills after hospital discharge. After external validation, an updated combined model had the best fit, with ordinal concordance of 0.646 (95% CI:0.615, 0.679). Over 1/3rd of patients were either not planning to dispose of unused opioids or had not yet decided how to handle unused pills. A nomogram was created to facilitate clinical use of the model. <h3>Conclusions:</h3> A prospectively constructed and validated model accurately estimates the number of opioid pills used by women after gynecologic surgery. Use of the GO-POP nomogram enables providers to tailor prescriptions using information available immediately following surgery. More work is needing to educate patients on the importance of disposal of unused opioids post-operatively to protect our communities.