October 30, 2017

How Bon Secours' St. Mary's Hospital reduced post-op opioids by 80 percent

Daily Briefing

    Bon Secours Richmond Health System's St. Mary's Hospital reduced post-operative opioid use for colorectal surgery patients by 80 percent through their Enhanced Recovery Program, which adjusted pre- and post-surgery practices, Katie O'Connor writes for the Richmond Times-Dispatch.

    How it works

    The program, which launched in August of 2016, changed protocols for colorectal surgical patients—both open and laparoscopic—before and after the procedure. According to Dennis Cohen, a surgeon at St. Mary's, some of the pre-operative changes included:

    • Allowing patients to consume clear liquids up to two hours prior to surgery;
    • Giving patients a nutritional supplement a few days prior to surgery; and
    • Encouraging patients to eat carbohydrates prior to surgery.

    After surgery, patients are:

    • Placed on a diet that minimalizes the need for IV fluids, tubes, and drains; and
    • Given fewer narcotics and more non-opioid painkillers, such as Tylenol or other anti-inflammatory drug.

    Positive results

    Since the program launched, the hospital has performed colorectal surgery on more than 100 patients, with an 80 percent decline in post-operative opioid use. Though some patients are sent home with a prescription for an opioid, they generally report in follow-up appointments that they did not fill the prescription, according to the hospital.

    Cohen added that while opioid use has declined, patients are still able to manage their pain. "The non-opioids that we're using manage their pain very well," he said. "There are a fair number of patients [who] require no narcotics at all while they're in the hospital."

    Further, the new protocols have enabled colorectal surgical patients to leave an average of two days earlier post surgery, which Cohen said provides significant psychological benefit to patients. "Nobody wants to be in the hospital," he said. "To be able to come in, have a major operation, and to be home (sooner) with no narcotics, is really ideal."

    Cohen has said that he hopes other hospitals within the Bon Secours Richmond Health System will use a similar program, and, according to O'Connor, surgeons from specialties outside of colorectal surgery have expressed interest in adopting the program (O'Connor, Richmond Times-Dispatch, 10/22).

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