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Practice Problem: Healthcare providers worldwide are working to battle the opioid epidemic and reduce opioid-related harm to patients. Utilizing evidence-based acute pain management methods to reduce opioid consumption is critical to combat the problem. PICOT: The PICOT question that guided this project was: In opioid-naïve adult patients undergoing general anesthesia for out-patient, minimally invasive abdominal wall hernia surgery, how does the implementation of an evidence-based, preventative Pain Control Optimization Pathway (POP) using a multimodal, opioid-sparing acute pain management technique and standardized procedure-specific opioid prescribing, compared to standard treatment, affect postoperative pain scores and opioid consumption, upon discharge from the recovery room and 72 hours postoperative? Evidence: Evidence supported utilizing a multimodal, opioid-sparing acute pain management technique, patient counseling, and opioid prescribing guidelines to improve outcomes among opioid-naïve patients undergoing abdominal surgeries. Intervention: In this preand post-intervention evaluation, N = 28 patients received the POP care process during the perioperative period. Outcome: Results showed the mean pain score at discharge from the recovery room decreased from 4.8 to 2.82 on the 10-point Numeric Rating Scale post-intervention (p< 0.001). Also, provider compliance with prescribing a procedure-specific opioid prescription increased from 73% to 100%, thus reducing opioid exposure and access. Conclusion: This project provided evidence that utilization of the innovative POP care process provided optimal pain control and decreased opioid consumption, consequently reducing the risk of new persistent opioid use. PAIN CONTROL OPTIMIZATION PATHWAY 4 A Pain Control Optimization Pathway to Reduce Acute Postoperative Pain and Opioid Consumption Postoperatively: An Approach to Battling the Opioid Epidemic The purpose of this DNP scholarly paper is to discuss an evidence-based change project that implemented an innovative Pain Control Optimization Pathway (POP) developed by Michigan Opioid Prescribing Engagement Network (OPEN) for reducing acute postoperative pain and opioid consumption as an effort to fight the opioid epidemic. The opioid epidemic is complex and multifactorial; therefore, managing acute perioperative pain becomes imperative as acute pain experiences are often the gateway for new persistent opioid use (OPEN, 2020). A strong body of scientific evidence supported using opioid-sparing acute pain management techniques, patient counseling, and procedure-specific opioid prescribing guidelines to improve outcomes for opioid-naïve patients undergoing out-patient, minimally invasive abdominal wall hernia surgery. Kotter’s 8-Step Change Model guided implementation of the preventative POP care process, which focused on preoperative and postoperative patient education and engagement, functional recovery goals, and opioid prescribing recommendations. Intraoperative anesthesia and postoperative care used a multimodal, opioid-sparing protocol as first-line treatment for acute pain, thus utilizing evidence-based techniques from Enhanced Recovery after Surgery, or ERAS (OPEN, 2020). The intervention provided uncompromising pain management, reduced opioid consumption, and showed patient satisfaction. This interdisciplinary approach to transforming perioperative surgical care has the potential to aid in curbing the opioid epidemic. Significance of the Practice Problem The opioid epidemic is a global problem that is tragically resulting in increased morbidity and mortality. It has evolved from a rise in opioid prescribing to control acute and chronic pain, the prevalence of misuse and diversion, and illicit and prescription opioid overdose-related PAIN CONTROL OPTIMIZATION PATHWAY 5 deaths (Clark & Schumacher, 2017). While once described as an epidemic in the United States, the opioid crisis is transitioning to a worldwide phenomenon resulting in disease burden and premature mortality (Degenhardt et al., 2014). Globally, in 2018, it was estimated 35.6 million individuals suffered from an opioid use disorder, and 0.5 million deaths were attributed to drug usage (World Health Organization [WHO], 2018). The United States is often blamed for starting the opioid epidemic and had a death rate reaching over 69,000 in 2019 (Centers for Disease Control and Prevention [CDC], 2019). The state of Michigan is not spared from the tragedy surrounding the opioid epidemic. In 2018, the death rate from overdose was over 2,500 compared to only 115 reported deaths in 1999 (Michigan Department of Health and Human Services [MDHHS], 2020). At the local level, Oakland County has seen a 267% increase in opioid-related deaths from 2009 to 2015 (Access Oakland, 2017). While the opioid epidemic is complex, managing acute postoperative pain is a critical component to reduce the risk of long-term opioid use. The problem is cyclical. Healthcare providers have an ethical responsibility to provide safe and high-quality acute postoperative pain management, but there is a link between prescribing opioids for acute pain and long-term use, even in opioid-naïve patients (OPEN, 2020). In the United States, nearly 50 million inpatient and outpatient surgical procedures are performed annually (Gan, 2017; Hah et al., 2017). More than 80% of patients receive opioids because they are the primary method of acute postoperative pain management (Hah et al., 2017). Unfortunately, up to 10% of opioid-naïve patients continue filling their opioid prescriptions one year following surgery (OPEN, 2020). Acute postoperative pain is devastating for the patient, family, healthcare system, and society. Patients with postoperative pain have an increased risk of suffering, morbidity and mortality, emotional complications, and delayed healing (Pogatzki-Zahn et al., 2017; Ramia et PAIN CONTROL OPTIMIZATION PATHWAY 6 al., 2017). There is an increased risk of negative physiologic effects, such as myocardial supply and demand mismatch, interruption of normal respiratory function, activation of the sympathetic nervous system, reduction in gastric motility, and coagulopathy (Bajwa et al., 2017). Emotionally, pain may lead to anxiety, depression, sleep disturbances, and even inhibit a patient’s ability to return to work and obtain an income (Bajwa et al., 2017). The anticipation of pain is a major source of preoperative anxiety for the patient and family. Additionally, an increasing number of outpatient surgeries are being performed, placing the burden of pain management and opioid weaning on patients and caregivers. Families routinely have questions for providers regarding postoperative pain management and counseling becomes vitally important. When acute postoperative pain is not managed appropriately, patient and family satisfaction is reduced, which is an important quality metric in healthcare (Ramia et al., 2017). Postoperative pain may prolong hospitalization and increase re-admission rates, which increases costs to the healthcare system. The American Academy of Pain Medicine (2019) estimated that pain costs society 560-635 billion dollars annually. Therefore, combating opioid abuse is a state and federal priority. In 2017, the state of Michigan signed a multi-bill to fight the epidemic, focusing on patient counseling, along with prescribing and dispensing regulations for providers

A Pain Control Optimization Pathway to Reduce Acute Postoperative Pain and Opioid Consumption Postoperatively: An Approach to Battling the Opioid Epidemic