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Impact of Enhanced Pre-Discharge Analgesic Counseling on Post-Discharge Knowledge Retention and Disposal of Unused Opioids Following Cesarean Delivery
Abstract Number: F3I-424
Abstract Type: Original Research
AIM: Opioids represent an important facet of multi-modal analgesia during recovery from Cesarean delivery, but there is concern that uninformed opioid use and misuse have contributed to the current public opioid abuse and diversion epidemic . We aim to assess the impact of enhanced pre-discharge counseling targeting analgesic strategies and opioid safety on knowledge retention and on disposal of unused opioids after discharge.
METHODS: IRB approval and informed consent were obtained. Women who underwent uncomplicated CD were randomized to receive Enhanced post-discharge analgesic counseling (E), which emphasizes scheduled non-opioid analgesics as first choice, as-needed use and tapering of opioid analgesics (OA), and proper disposal of unused OA; or to Standard discharge counseling (S). A 10-question quiz designed to confirm understanding was administered to Group E after counseling E1, and to both groups 14 days after discharge (E2, S2). All participants were discharged with ibuprofen and 30 opioid tablets. The 14-day follow-up survey asked patients what they had done with unused OA. Test performance was compared between groups, as was reported disposal of OA.
RESULTS: From Aug 2018 to Jan 2019, 196 women provided consent, participated, and were randomized (97 E; 99 S). 97 (100%) completed E1, 82 (85%) E2, 83 (84%) S2. Knowledge retention was evident 2 weeks after discharge in the E group (95% total correct in E1 vs 92% E2, p<0.05), and E outperformed S at 14 days (92% E2 vs 78% S2, p<0.05). The greatest variance in correct responses related to recommended disposal of unused opioids 94%(E) vs 46%(S) and opioid addiction potential 99%(E) vs 73%(S). Of 149 subjects with leftover OA who reported disposition (E 76; S 73), the proportion of group E subjects that properly discarded leftover OA was greater than that of S (53% vs 29%, p<0.05). The proportion reporting keeping OA in an unlocked location was similar (21% E vs 32% S, p>0.05).
CONCLUSIONS: Pre-discharge counseling represents an important opportunity for education regarding safe and effective multi-modal analgesia, and appropriate disposal of unused OA. Our results demonstrate that enhanced, targeted pre-discharge counseling knowledge is retained 2 weeks after discharge, and is associated with a nearly 2-fold higher rate of proper disposal of leftover OA.
REF: 1) www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdf, Aug 31 2018