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patients asked about pain after surgery and also learned about how they viewed prescription taking. A few patients we spoke with had only taken antibiotics up to this point, and since antibiotic prescriptions are to be taken until all the pills are gone, they assumed that they were supposed to finish the entire prescription for pain medication, even if they didn’t have any pain. They were also given no clear expectation about what kind of pain to expect and how to manage it. Some expected to be pain free despite having had surgery. Use of non- steroidal anti-inflammatory medications was not always emphasized as the primary form of pain relief after surgery, with an opioid only for breakthrough pain.
These observations allowed us to institute some simple changes, mostly aimed at setting expectations. Patients were counseled that they can expect pain. We let them know which medications they could take and how many pills the average patient requires after this procedure. And we informed them that it was perfectly fine to not use an entire prescription. In fact, our data showed that they likely wouldn’t need to! This informa- tion was shared with the physician assistants who staff the pre-op clinics so they could appropriately counsel patients about pain management.
The same information had to be shared with the nursing staff in the ambulatory surgery unit, so that the messages that patients received after operation and prior to discharge was consistent with what they had been told pre-operatively.
Lastly, even though patients would now hopefully have less opioid pain medication leftover, we still wanted to make sure they knew how and where to dispose of
unused opioid drugs. There are actually over 400 sites in the state of Michigan that accept opioids for safe disposal, but this information is not well-known and is difficult to find. We designed an easy-to-use online map based on Google Maps, a tool that most patients are familiar with. With this tool, patients can simply enter their home zip code to find the disposal sites nearest to them. This tool can be found at
What was the impact of this project? Did we change practice for the better? In the first month since our guideline was introduced, average opioid prescription size following laparoscopic cholecystectomy has decreased by more than half with no increase in the number of requests for refills. This means that the equivalent of roughly 1,000 tablets of Norco 5/325 have been kept out of our community.
It has been exciting to see this change process build momentum. Since introducing our mapping tool, nurses at the outpatient surgery center have found it so helpful that they’ve begun using it to help patients undergoing other procedures, not just laparoscopic cholecystectomy, to find disposal sites for unused drugs. Other surgical services have already begun developing prescribing guidelines for their own procedures as well. As this project continues and expands, we hope to see the number of excess pills kept out of the community increase by 100-fold or more and be counted in the millions.
The important life lesson I have learned by engaging in real-world learning as a medical student is that it is possible to reduce the amount of unused and, therefore, dangerous opioid drugs in our communities by identifying a problem and setting out to actually fix it.
New Officers and Delegates Elected at November 16, 2016 General Session
T he 2017 WCMS Ballot was presented and the slate of officers,delegates,and alternate delegate were elected.The 2017 officers are: Joseph Nnodim, MD,
President-Elect; Barbara A.Threatt, MD, Secretary; and Martha L. Gray, MD,Treasurer.
The three members elected for a two-year term (2017- 2018) as Delegates to the MSMS House of Delegates are: Samuel Mackenzie, MD, PhD; Christopher Petrilli, MD; and Natalie Schellpfeffer, MD.
The Alternate Delegate elected was Andrew R. Barnosky, DO, MPH.
Volume 69 • Number 1 Washtenaw County Medical Society BULLETIN 15

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