In early 2018 the Gynecologic Oncology division partnered with UAB Care to take action against the opioid crisis. Dr. Michael Straughn, fellowship director for the division, approached the UAB Care team in March 2018 following the 2018 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer where the topic of reducing opioid prescriptions was of great interest for all. After hearing from a guest speaker, doing research, and learning of best practices from other institutions, the GYN Oncology team decided it was time to do its part in addressing prescribing behaviors for acute pain after surgery. Furthermore, the team identified the need to provide education and resources to patients and family members on the tools and methods for disposing of unused opioids.

The project was launched in May 2018 through an interdisciplinary team of surgeons, nurses, clinical informaticists, and data analysts. The team developed a four-tier approach to opioid prescribing guidelines for all patients undergoing a surgery discharged by the GYN Oncology service. In addition, the team created standardized patient and family education on appropriate opioid disposal at home. The project went live in August 2018 after all disciplines involved were educated on the project and the interventions.

Preliminary results indicated an average decrease of approximately 10 tablets per prescription (pills) from FY 2017 to FY 2018 without an increase in the need for refills or readmission/UED visits. The team is hopeful that the results will be greater as the new process is hardwired and followed by all in the GYN Oncology division. The division and its leadership are committed and engaged to making an impact in the face of the opioid crisis in order to improve patient outcomes and provide high quality care.

The Intervention

  • Created a standardized prescribing pathway for writing postoperative discharge opioid prescriptions that includes:
    • Multi-modal pain approach
    • Four-tier system for prescribing opioids
    • Process for when to initiate and write prescriptions for opioids was determined
    • Discharge power plan
  • Developed a standardized pathway to triage and write additional postoperative opioid prescriptions
    • Triage assessment questions and patient education
    • Escalation process
  • Created standardized opioid patient and family education
  • Developed patient survey to monitor new processes, patient satisfaction, and opioid disposal 

Gynecologic Oncology Opioid Prescription and Disposal Team Members

  • Executive Sponsor: Dr. Warren Huh
  • Physician Project Leads: Drs. Michael Straughn and Haller Smith
  • Administrative Project Lead: Allison Todd, Manager of Quality and Clinical Data
  • Nursing Project Leads: Erika Lumpkin and Carissa Purvis
  • UAB Care Team Lead: Laura Leal
  • Other vital clinical team members from various areas including: advanced enterprise analytics, clinical informatics, GYN/ONC, perioperative services, pharmacy, and UAB Care that were integral to the success of this project

Celebration Data Powerpoint (pdf)

GYN Onc Opioid Poster