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Opioid Stewardship: A Quality Improvement Initiative
Abstract Number: F3I-485
Abstract Type: Original Research
Intro: Overprescription of opioids is common after CD and contributes to the opioid crisis. Our ongoing QI initiative focuses on CD analgesia, opioid prescribing, and patient education. The first phase aimed to reduce inpatient opioid use. The second phase aimed to reduce opioid overprescription.
Methods: Phase 1: Prior to Oct 2016, patients received variable PRN NSAID regimens, PRN opioid-acetaminophen tabs, and IV opioids. In Oct 2016, an anesthesia-created order set of scheduled NSAIDs and acetaminophen and PRN oral oxycodone was implemented. Outcome measures included opioid consumption 0-24, 25-48, and 49-72 hrs postpartum, length of stay (LOS), and proportion of patients using no opioids.
Phase 2: In Jun 2017, it was recommended providers standardly prescribe 20 tabs of oxycodone. In Nov 2018, select providers began using a simple algorithm to tailor opioid prescribing. At the time of discharge, the number of opioid tabs used in the last 24 hrs was multiplied by 5 to determine the amount to prescribe. To assess phase 2, we compared the number of tabs prescribed to all patients and a subgroup who did not use opioids in the 24 hrs prior to discharge for 4 groups. Baseline group (BG) = Mar 2017; Standardized group (SG) = Aug 2017; Standard provider group (SP) = Dec 2018 and Tailored prescribing group (TP) = Dec 2018. Other outcome measures included inpatient opioid consumption, LOS, and patient satisfaction.
Results: The pre-multimodal group (PMG) consumed a mean of 95.6 MME (SD 86.1) compared to a mean of 61.1 MME (SD 95.1) in the scheduled multimodal group (MG) in the first 48 hrs post-CD (p<0.0001). 3.0% (21 of 697) of the PMG did not receive opioids in the first 48 hrs compared to 18.3% (150 of 818) of the MG (p<0.0001).
The median number of tabs prescribed were: BG = 30 [11.25-45]; SG = 20 [20-30]; SP = 20 [20-20]; TP = 10 [5-20] (p<0.05). Table shows the prescribing pattern for a subgroup of patients who were not using opioids.
Discussion: Using a scheduled multimodal analgesic regimen significantly reduced inpatient opioid use. A tailored opioid prescribing practice reduced the overprescribing of opioids. QI initiative success relies on sustained buy-in from all disciplines which has been achieved by introducing phased changes, high-level communication, and demonstrating positive results. Moving forward we plan to extend tailored prescribing to all providers.
Bateman. Obstet Gynecol 2017.
Valentine. IJOA 2015.
Hill. J Am Coll Surg 2017