Date of Degree

Fall 2023

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type


Degree Name

Doctor of Nursing Practice

First Advisor

Dr. Debbie Conner

Second Advisor

Dr. Melanie Brewer


Problem: The opioid epidemic is magnified by excessive post-surgery prescriptions. Over six months at an orthopedic spine practice, 50% of patients received two or more opioid refills beyond their first. This highlighted the absence of a clear prescribing policy and emphasized the need for a structured protocol and to promote patient safety.

Aim of the Project: The primary aim was to implement a prescribing protocol to lower opioid refills provided to post-surgical patients in this surgical practice. The desired result was to reduce the number of opioid refills provided to patients after surgery.

Review of the Evidence: Evidence highlighted substantial support for prescribing protocols. Utilizing specific post-surgery opioid prescribing methods may reduce opioid use and refills. The project protocol, modeled after the University of Michigan’s Pain Management Toolkit patient agreement, was developed using multiple national guidelines.

Project Design: This quality improvement project employed the Institute for Healthcare Improvement’s Plan-Do-Study-Act model. After each cycle, the team analyzed data to pinpoint areas for improvement. The OhioHealth Change Management model tools were crucial in steering the change process. Challenges were discussed in brainstorming sessions, and solutions were devised and implemented to address these obstacles.

Intervention: Before surgery, patients signed the project protocol which was reviewed once more on the day of surgery. This protocol encompassed a weaning plan and highlighted alternative pain control methods. At each post-operative check, surveys gauged pain levels and compliance, ensuring consistent adherence.

Significant Findings/Outcomes: The first outcome aimed to reduce the number of opioid refills prescribed by 75%, and it surpassed this goal by reaching 97%. The second outcome was achieved, ensuring all patients requiring medication beyond eight weeks were referred to pain management or primary care. Additionally, 97% of patients signed the protocol prior to surgery.

Implications for Nursing: This project aligns with the Six Aims of Healthcare Quality outlined by the Institute of Medicine and promoted by the Agency for Healthcare Research and Quality: to provide care that is safe, effective, patient-centered, timely, efficient, and equitable. Additionally, in line with the Institute for Healthcare Improvement's Triple Aim, the project protocol advances better patient outcomes, improves the patient experience, and addresses the opioid crisis by reducing over-prescribing post-surgery.


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