240: Patient-centered determination of quantity of opioid analgesic at time of discharge after cesarean delivery

Abstract

OBJECTIVE:To determine the median use of opioid analgesic in the last 24 hours prior to discharge following cesarean delivery and the feasibility of an automated inpatient report to facilitate quantity of opioids indicated for discharge. STUDY DESIGN: Previously, all cesarean deliveries received a set number of opioids at the time of discharge regardless of use while inpatient. In an effort to minimize opioid use while inpatient, a multimodal approach was taken which included the separation of acetaminophen from opioids and scheduling of acetaminophen and non-steroidal anti-inflammatory drugs with opioid use reserved for breakthrough pain. An inpatient report was created which calculated total quantity of 5mg tabs of Roxicodone used in last 24 hours prior to discharge. A 5-day supply of opioids was then prescribed which was individualized based on the last 24-hour intake with a maximum of 40 tabs given. The median, interquartile range, 90 th percentile, and percent of patients requiring zero opioids was determined. RESULTS: There were 129 patients included in this review who underwent a cesarean delivery with a median time from delivery to discharge of 57.7 hours. The median number Roxicodone 5mg tabs given in the last 24 hours prior to discharge was 2 (interquartile range 0 to 4). The 90th percentile was 7 tabs with a maximum of 14. Prior to institution of this quality improvement project, all patients were discharged with 32 tabs of 5mg Roxicodone. After implementation, the median amount was 10 tabs given at discharge with an interquartile range of 0 to 20. Fifty patients (38.8%) required no opioids for last 24 hours prior to discharge. The report was printed daily and made available for obstetric providers to aid in personalizing discharge quantity of opioids. CONCLUSION: With the use of the electronic medical record and automated inpatient narcotic use report, the quantity of opioids at the time of discharge following cesarean delivery can be easily customized with an overall reduction in the amount of opioids dispensed for home use.241 Maternal perception of birth trauma and its association with postpartum mood and parenting stress