Adoption of a single metropolitan government for Nashville and Davidson County in 1962, at a time when many metro reform proposals have been rejected elsewhere, provides an opportunity to examine the role of professional political leaders in its formulation and adoption. Thirty years of Nashville suburban spillover without annexation led to the familiar pattern of a service vacuum, inequalities, rivalries, and confused responsibility. During the 1950's, two surveys by professional staffs, working closely with the Nashville mayor and a rival Davidson County judge, led to a proposal for major structural change (city-county consolidation) which was en dorsed by both the mayor and the judge. Their support was undoubtedly helpful in the 1958 metro campaign, but it was rejected by the voters outside Nashville. Two windfall issues —annexation and an auto tax—and the opposition of the Nashville mayor contributed to a new and successful metro vote in 1962. The Nashville experience indicates that active involvement of rival professional political leaders in all stages of a metro reform movement is possible, is not necessarily a kiss of death, does not prevent "radical reform," and may actually constitute a tactical advantage for metropolitan reformers.
OBJECTIVES:
To investigate prescription opiate usage, disposal rates, and methods of disposal after pediatric surgery.
METHODS:
This was a retrospective chart review of patients <18 years of age who underwent a surgical procedure at our institution and were given a postoperative opiate prescription between April 2017 and June 2018. A follow-up phone survey was conducted between 60 and 90 days postoperatively to ask about prescription opiate usage and disposal.
RESULTS:
A total of 290 patients with a mean age of 9.0 ± 4.7 years (62.8% male) met inclusion criteria. Sixty patients (20.7%) reported using all of their prescription opiate medication, whereas 230 patients (79.3%) did not use all of their pain medication. Of these 230 patients, 141 (61.3%) disposed of their leftover prescription opiates via flushing (56.4%), trash (28.6%), or take-back center (15.0%). At the time of phone survey between 60 and 90 days postoperatively, 88 patients (38.3%) still had leftover pain medication. By 7 days postoperatively, 234 of 290 patients (80.7%) had taken their last prescription opioid.
CONCLUSIONS:
In our study, 79.3% of patients were overprescribed opiate pain medication after pediatric surgery. Disposal rates at 60 to 90 days for leftover pain medication after pediatric surgery was just >60%. Pediatric patients are often overprescribed prescription opiates after surgery and typically only require a one-week supply of pain medication.
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