INTRODUCTION: As the scope of the opioid-addiction epidemic increases, so does the need for supportive providers and for comprehensive interventions to best manage a patient’s addiction. Treating pain following cesarean section necessitates such an intervention as hyperalgesia and increased tolerance have been well established in patients treated with methadone and buprenorphine. METHODS: A quality improvement project was conducted to guide postoperative pain control for patients on medication assisted treatment (MAT) through the University of Massachusetts Medical School’s Green Clinic for Addiction and Recovery. Providers were instructed to administer a regimen of increased post-operative opiate pain medication for an initial cohort of Green clinic patients scheduled to undergo a primary or repeat cesarean section. A retrospective chart review was then conducted, collecting pain scores and quantity of opiate pain medication given from the time of delivery to 72 hours post-operative. Adherence to the protocol was determined by type and quantity of pain medication received. RESULTS: Of 16 Green clinic patients to receive the protocol, only 41% of patients received the treatment protocol and the remaining 59% received standard post-operative orders. There was no significant difference in pain scores between groups receiving the treatment protocol vs. those receiving standard postoperative orders. CONCLUSION: Failure to follow the protocol for patients on MAT indicates the need for more effective systems-based implementation protocols but also the need for concurrent education of healthcare workers involved in the care of patients with addiction, as stigma and knowledge gaps cannot be excluded as factors contributing to failure to follow the protocol.
INTRODUCTION: Inappropriate storage and disposal of unused opioids presents a growing public health and safety issue. This is of special interest when caring for women undergoing surgery for gynecologic conditions, such as cancer, as there is increasing evidence of overprescribing in the post-operative period. This study investigates opioid storage and disposal practices among post-operative gynecologic oncology patients. METHODS: We developed and administered a cross-sectional survey among patients who underwent surgery for gynecologic cancer or cancer precursors between October 2017–January 2019. The survey tool assessed self-reported opioid use, storage, and disposal practices as defined according to FDA guidelines. Additional data was abstracted regarding inpatient opioid requirement prior to discharge and baseline risks factors for opioid misuse. IRB approval was obtained. RESULTS: 297 patients met inclusion criteria. The average opioid requirement on the day of discharge was 12.9 MME (morphine milligram equivalents) with average discharge amount prescribed being 180.4 MME. 70.4% reported use of 50% or less of the opioids prescribed, and 62% reported keeping their unused opioids. 75% reported unsafe storage. 26% reported personally using leftover opioid pain medication for reasons unrelated to the surgery. Only 30.4% reported using a designated drop site for opioid disposal. Only 38.3% recalled receiving information on safe opioid storage and disposal during their care. CONCLUSION: There is significant overprescribing of opioids in gynecologic oncology patients postoperatively. Increased collaborative patient and prescriber education regarding safe opioid storage and disposal is paramount for future efforts to prevent diversion, accidental ingestion, and chronic opioid use.
ObjectiveThe aim of the study was to evaluate the quality of patient-focused websites addressing postpartum pelvic floor health.MethodsThe Google search engine was used to perform a search of the following 3 terms: (1) “postpartum pelvic floor (PPF),” (2) “postpartum leaking urine (PLU),” and (3) “postpartum leaking stool (PLS).” The top 20 results from each search term were evaluated using the DISCERN quality appraisal tool and Journal of the American Medical Association (JAMA) benchmark criteria by 2 independent researchers. Websites were also categorized by type. Cohen κ was performed to determine interrater reliability between reviewers. The Kruskal-Wallis test was used to evaluate the differences in DISCERN and JAMA criteria scores.ResultsThe weighted mean κ between the investigators for each search term was κ = 0.47 (range = 0.163 [PPF] to 0.759 [PLU]), suggesting moderate agreement between reviewers. There was a significant difference in mean DISCERN scores between the terms, with “postpartum leaking urine” yielding the highest mean score. When comparing DISCERN scores by category, society- and government-sponsored websites (mean = 55 ± 13) scored significantly higher than other categories. Using JAMA criteria, mean scores ranged between 1.83 and 2.83/4, but there were no significant differences between websites.ConclusionsThe overall quality of health information available on the internet regarding postpartum pelvic health is low. Higher-quality search results are found within society- and government-sponsored websites as well as under the search term “postpartum leaking urine.” It is important for health care providers to guide their patients to websites with reliable information about postpartum pelvic floor recovery.
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