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Opioid Reduction Through Postoperative Pain Management in Pediatric Orthopedic Surgery
- Source :
- Pediatrics. 148(6)
- Publication Year :
- 2021
-
Abstract
- OBJECTIVES Our goal with this initiative was to reduce discharge opioid prescriptions while maintaining optimal pain management through the use of standardized pain prescribing guidelines for pediatric patients after orthopedic surgical procedures. METHODS Through analysis of established yet inconsistent prescribing practices, we created a 4-tiered guideline for pediatric orthopedic postoperative pain management prescription ordering. Following the Model for Improvement methodology including iterative plan-do-study-act cycles, the team created an electronic medical record order set to be used at discharge from the hospital. The provider compliance with this order set was monitored and analyzed over time by using provider-level and aggregate control charts. A secondary measure of opioid prescriptions (morphine milligram Eq [MME] dosage per patient) was tracked over time. The balancing measure was the analysis of unanticipated opioid prescription refills. RESULTS Greater than 90% compliance with the guidelines was achieved and sustained for 20 months. This resulted in a 54% reduction in opioids prescribed during the improvement period (baseline = 71 MME per patient; postintervention = 33 MME per patient) and has been sustained for 12 months. The percentage of unanticipated opioid prescription refills did not significantly change from the period before the institution of the guidelines and after institution of the guidelines (2017 = 3%; 2019 = 3%). CONCLUSIONS The creation of these guidelines has led to a significant reduction in the number of opioids prescribed while maintaining effective postoperative pain management.
- Subjects :
- Male
medicine.medical_specialty
Adolescent
medicine.medical_treatment
MEDLINE
Electronic Prescribing
medicine
Electronic Health Records
Humans
Pain Management
Orthopedic Procedures
Medical prescription
Child
Reduction (orthopedic surgery)
Pain, Postoperative
Morphine
business.industry
Orthopedic Surgical Procedure
Guideline
Analgesics, Opioid
Opioid
Pediatrics, Perinatology and Child Health
Emergency medicine
Orthopedic surgery
Female
business
medicine.drug
Subjects
Details
- ISSN :
- 10984275
- Volume :
- 148
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Pediatrics
- Accession number :
- edsair.doi.dedup.....158b7fcc84eb3d52aa601734f45b3a4f