Cut the Count: New Surgical Quality Improvement Campaign

2020-21 Surgical Quality Improvement Campaign

Hospitals are coming together for a second year to help patients effectively manage pain while continuing to Cut the Count—reduce the number of opioid pills they prescribe to surgical patients at discharge (where appropriate).

Maintaining momentum

This year, choose at least one new procedure and make one change :

Adopt a common prescribing protocol;
Use multimodal pain management; and/or
Talk to your patients about safe opioid use and other treatment options.

Cut the Count is a “Committed to Better” campaign involving 46 hospital sites across Ontario that are part of the Ontario Surgical Quality Improvement Network.

Why reduce the number of pills prescribed at discharge

Opioid prescriptions for acute pain after surgeries are among the highest in Ontario, and the province’s surgical community recognizes the important role surgeons can play in reducing opioid-related harms.

If patients are prescribed more pills than they need at discharge, they may end up taking many or all of them and developing a dependency. Or, if they don’t take all the pills prescribed to them—which studies show is often the case—this can add to the supply of opioids in the public domain that may be used inappropriately.

There are other treatment options (both pharmacological and non-pharmacological) to support patients in their post-surgical recovery.

The Cut the Count campaign is designed to help you manage your patients’ pain effectively, while decreasing the dose and duration of opioids prescribed after surgery. The information below will help you do this.

How to get started

Approximately 72% of patients undergoing surgery in the province will be discharged from an Ontario Surgical Quality Improvement Network member hospital.

Between April 1, 2020, and March 31, 2021, Surgical Network hospitals, supported by Ontario Health (Quality), are coming together for a second year to Cut the Count and reduce the number of opioid pills their surgical teams prescribe to patients at discharge.

Other hospitals can join the challenge too.

Here’s how to get started:

Tools and resources

Quality Standard: Opioid Prescribing for Acute Pain

Learn more about opioid prescribing for acute pain using this quality standard produced by Ontario Health (Quality) in consultation with clinical experts and patients. It outlines for clinicians what high-quality care looks like when prescribing opioids and is based on the best evidence.

Share its accompanying patient guide with your patients to help them ask informed questions about opioid prescribing and additional techniques they could use to help them manage their pain post-surgery.

NEW Quality Standard: Transitions Between Hospital and Home

This quality standard addresses care for people of all ages transitioning (moving) between hospital and home after a hospital admission. It focuses on people who have been admitted as inpatients and who require ongoing coordinated follow-up medical care, including medication and opioid review and support, after discharge.

Share its accompanying patient guide with your patients to help them ask informed questions about their transition plan, including getting a written transition plan that includes information about taking their medications safely.

NEW: MyPracticeReport: General Surgery

General surgeons who perform appendectomies, cholecystectomies, and select hernia repairs can sign up to receive a confidential practice report that offers personalized data on your opioid prescribing patterns in relation to your peers. Suggestions and tools to support quality improvement efforts are also included.

MyPractice Report: Orthopaedic Surgery

Orthopaedic surgeons who perform hip and knee replacements can sign up to receive a confidential practice report that includes personalized data on your opioid prescribing patterns, along with suggestions to help improve care for your patients.

Local Initiatives

Many organizations and hospitals are already taking steps to change their opioid prescribing habits and educate their patients and other health care providers about multimodal pain management.

If you’re a member of the Ontario Surgical Quality Improvement Network, you’ve been receiving updates about these local initiatives through the Surgical Network’s Community of Practice.

If you’re not a member, but are interested in learning more about local initiatives, email ONSQIN@hqontario.ca.

How to talk with your patients about opioid use after surgery

People who are about to have surgery might be apprehensive about recovery and fearful of post-surgical pain affecting their daily lives. Talk to your patients and their caregivers about what to expect and different ways to manage pain after surgery. It is important to be clear that reducing opioids does not mean increased pain nor does it mean the absence of pain management.

Start the conversation:

Patient conversation guide (please share with your patients)
Poster for patients (for clinicians to print and hang in their waiting rooms)

Share your participation

Communications Materials

Celebrate and share that your hospital is taking on the Cut the Count challenge. Here are some suggested communications tools you may find helpful:

Poster for clinicians (to print and hang in their surgical suites)
Poster for patients (for clinicians to print and hang in their waiting rooms)

Quorum

Members of the Ontario Surgical Quality Improvement Network: engage with others and exchange success stories and challenges on Quorum, an online quality improvement forum.

Also, share tools, resources and best practices on what your hospital is doing to Cut the Count.

Education and webinars

To come.

About the Ontario Surgical Quality Improvement Network

The Ontario Surgical Quality Improvement Network is a Community of Practice that brings together surgical teams from all hospitals and specialties from across the province to improve the quality of surgical care.

For more information on the Cut the Count campaign or to join the Ontario Surgical Quality Improvement Network, please contact ONSQIN@hqontario.ca.

Quality Improvement