BACKGROUND: In line with a nationwide commitment to decrease opioid prescribing, in October 2017, our department implemented a new departmental policy to cease routine provision of opioid prescriptions at the time of discharge following vaginal delivery. OBJECTIVE: This study aimed to evaluate the effect of this policy on the number of discharge opioid prescriptions provided and outpatient encounters observed postpartum. STUDY DESIGN: This was a retrospective cohort study of patients who underwent vaginal delivery at our institution from November 2016 to January 2018. We reviewed delivery and postpartum records for patients 18 years or older, without chronic opioid use or contraindication to nonsteroidal antiinflammatory medication use. The primary outcome was the proportion of patients provided with an opioid prescription at the time of discharge following vaginal delivery. The secondary outcome was the number of unscheduled patient encounters related to pain in the 6-week postpartum period. Fisher's exact test was used to compare these outcomes before and after implementation of the new departmental opioid-prescribing policy. RESULTS: A total of 1188 charts were reviewed; among those charts, 810 met the inclusion criteria. Notably, 405 patients delivered before the guideline, and 405 patients delivered after its implementation. After the implementation of the new departmental policy, there was a 10-fold decrease in opioid prescriptions provided from 323 (79.8%) to 29 (7.2%) (P<.01). Although the number of unscheduled outpatient encounters postpartum increased slightly from 22 to 37 encounters after the implementation of the new departmental policy, this difference was not statistically significant (P¼.08). CONCLUSION: Limiting opioid prescribing after vaginal delivery is associated with a considerable decrease in the number of discharge opioid prescriptions provided and does not significantly increase the number of outpatient encounters related to pain postpartum.
INTRODUCTION: In line with nationwide commitment to decrease opioid prescribing, our department instituted new guidelines to no longer routinely provide opioids at discharge following vaginal delivery. The purpose of this study was to measure the effect of this change on discharge opioid prescriptions and postpartum encounters. METHODS: This was a retrospective cohort study of patients who underwent vaginal delivery during two time periods: November 2016 to January 2017 before the guideline and November 2017 to January 2018 after its implementation. IRB approval was obtained. Exclusion criteria included substance use disorder history, age under 18 and having a contraindication for nonopioid analgesic use. The number of patients who were provided discharge opioid prescriptions or had an outpatient encounter related to pain within six weeks postpartum were compared using Student t-tests. RESULTS: A total of 1,188 patients delivered during the study periods, of those 810 met inclusion criteria. 405 patients delivered prior to the guideline and 405 after its implementation. The proportion of patients prescribed opioids decreased from 79.8% (n=323) to 7.2% (n=29) after the guideline (p<0.001). The number of patients who had a post-discharge outpatient encounter (either in the Emergency Department, clinic or via phone call) related to pain did not change (4% before and 6.7% after the guideline; p = 0.085). The majority of encounters were related to dysuria and pain around repaired lacerations. CONCLUSION: Substantially limiting opioid prescribing after vaginal delivery does not appear to increase the burden of outpatient patient encounters after discharge.
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