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Implementation of an Iterative Approach to Decreasing Opioid Prescribing after Cesarean Delivery
Abstract Number: O1-3
Abstract Type: Original Research
The use of opioids for postoperative pain management after cesarean delivery (CD) is common. A study of shared decision-making to guide opioid prescribing at our institution resulted in a decrease from 40 to 20 tablets of oxycodone 5mg prescribed at discharge. (1) As a quality improvement (QI) project, we sought to implement the study’s core principles to decrease opioid prescribing.
The QI project was instituted on November 7, 2016 and comprised of 1) a collaborative discussion with patients about outpatient expectations for pain and normative use of opioids, 2) a prescription for acetaminophen, and 3) a discharge opioid prescription informed by patient choice, up to a maximum of 30 oxycodone 5mg tablets or equivalent (Phase 1). We had an a priori plan to analyze the intervention’s impact on the mean number of opioid tablets prescribed and opioid refill rate in the first 30 days post-discharge, with a goal to iteratively adjust the maximum quantity of opioid tablets. Data for Phase 1 were abstracted 2 months pre- and post-intervention. Phase 1 findings were shared with discharging providers, and the intervention was modified to lower the maximum threshold of oxycodone 5mg to 25 tablets or equivalent on June 10, 217. Data were abstracted 1 month pre- and 2 months post-intervention (Phase 2).
Data from 633 uncomplicated CDs were analyzed. The mean maternal age was over 30, over half were Caucasian, and the median gestational age at delivery was 39 weeks. Opioids, most commonly oxycodone, were prescribed after 95% of CDs during all time points (Table). In Phase 1, the mean number of opioid tablets prescribed decreased from 33.2 to 26.6, p<0.01, with no impact on the opioid refill rate. In Phase 2, the mean number of opioid tablets prescribed decreased from 24.9 to 21.5, p<0.01, with no impact on the opioid refill rate. Acetaminophen prescriptions increased significantly during Phase 1, from 33.7% to 77.3%, p<0.01 and were greater than 90% during Phase 2. Ibuprofen prescribing was high at all time points.
Through the iterative study of this intervention, we observed a 35% reduction in the number of opioid tablets prescribed after CD at our institution, without any impact on the opioid refill rate, suggesting adequate outpatient pain management. Implementing a simple, evidence-based intervention can have a substantial impact on mitigating the quantity of opioids prescribed.
1.Prabhu, Obstet Gynecol, 2017