Impact of an opioid stewardship program on opioid exposure for pediatric appendectomy postsurgical pain

Creamer, Mackenzie; Trinkman, Heidi; Hamby, Tyler; Williams, Lorrainea; Carroll, Matthew; Gandhi, Artee

doi:10.1016/j.jpedsurg.2020.09.067

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…33 Studies also diverge in their understanding of stewardship and conflate OSPs with other opioid interventions. Interventions that focus on reducing opioid exposure within specific populations like pediatric appendectomy patients 34 or pediatric patients with perioperative pain 35 are important, but they are too limited in scope to be labeled as OSP programs. Lack of standardization can impede OSP development and lead to an incomplete or overly narrow focus.…”

Section: Discussionmentioning

confidence: 99%

Opioid stewardship program implementation in rural and critical access hospitals in Arizona

Brady,

SantaMaria,

Tucker Ortiz y Pino

et al. 2024

J of Opioid Management

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Objective: The objective of this study is to examine rural hospitals' status in implementing opioid stewardship program (OSP) elements and assess differences in implementation in emergency department (ED) and acute inpatient departments. Design: Health administrator survey to identify the number and type of OSP elements that each hospital has implemented. Setting: Arizona critical access hospitals (CAHs). Participants: ED and acute inpatient department heads at 17 Arizona CAHs (total of 34 assessments). Main outcome measures: Implementation of 11 OSP elements, by department (ED vs inpatient) and prevention orientation (primary vs tertiary). Results: The percentage of implemented elements ranged from 35 to 94 percent in EDs and 24 to 88 percent in acute care departments. Reviewing the prescription drug monitoring program database and offering alternatives to opioids were the most frequently implemented. Assessing opioid use disorder (OUD) and prescribing naloxone were among the least. The number of implemented elements tended to be uniform across departments. We found that CAHs implemented, on average, 67 percent of elements that prevent unnecessary opioid use and 54 percent of elements that treat OUD. Conclusions: Some OSP elements were in place in nearly every Arizona CAH, while others were present in only a quarter or a third of hospitals. To improve, more attention is needed to define and standardize OSPs. Equal priority should be given to preventing unnecessary opioid initiation and treating opioid misuse or OUD, as well as quality control strategies that provide an opportunity for continuous improvement.

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Section: Discussionmentioning

confidence: 99%

Opioid stewardship program implementation in rural and critical access hospitals in Arizona

Brady,

SantaMaria,

Tucker Ortiz y Pino

et al. 2024

J of Opioid Management

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“…2 As such, there has been increased interest in minimizing the use of opioids and implementing nonopioid options for postoperative pain. [3][4][5][6] Studies have shown that there is wide variability in opioid prescribing patterns after adult and pediatric elective surgery. [7][8][9][10][11] Orthopaedic surgeons are among the most frequent prescribers of opioids.…”

mentioning

confidence: 99%

“…This presents a critical time when surgeons may influence, positively or negatively, the risk of future opioid dependence 2. As such, there has been increased interest in minimizing the use of opioids and implementing nonopioid options for postoperative pain 3–6. Studies have shown that there is wide variability in opioid prescribing patterns after adult and pediatric elective surgery 7–11.…”

mentioning

confidence: 99%

Tiered Guidelines in a Pediatric Orthopaedic Practice Reduce Opioids Prescribed at Discharge

Baker

Larson

Ubl

et al. 2021

Journal of Pediatric Orthopaedics

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Background: Data regarding opioid prescribing patterns following pediatric orthopaedic procedures is limited. The aim of this work was to evaluate the effects of tiered guidelines for discharge opioid prescriptions following common pediatric orthopaedic procedures. Methods: Quality improvement project conducted at a single academic institution. Guidelines for discharge opioid prescriptions were implemented January 2018 and established 4 tiers of increasing invasiveness for 28 common pediatric orthopaedic procedures. Patients who underwent these procedures in 2017 comprised the preguideline cohort (N = 258), while patients treated in 2019 comprised the postguideline cohort (N = 212). Opioid prescriptions were reported as oral morphine equivalents (OMEs). Univariate tests were performed to assess statistically significant differences before and after implementation of the guidelines. Results: There was a significant decrease in OME prescribed between preguideline and postguideline cohorts (median OME 97.5 vs. 37.5). When analyzed according to procedure tiers, tiers 1, 2, and 4 showed significant decreases in OME prescribed between 2017 and 2019. The rate of no opioids prescribed at discharge increased from 13% to 23% between preguideline and postguideline cohorts. The 30-day refill rate did not significantly change. After implementation of guidelines, 91% of all prescriptions were within the guideline parameters, and there was a significant reduction in prescription variability. In tier 4 procedures, median OME prescribed decreased from 375 preguideline to 188 postguideline, but was associated with greater opioid refills within 30 days of discharge (10.2% preguideline vs. 28.8% postguideline). Conclusions: Tiered guidelines for discharge opioid prescriptions following pediatric orthopaedic procedures can significantly decrease the quantity of opioids prescribed. Furthermore, we noted excellent adherence and no overall increase in the rates of narcotic refills. Such guidelines may improve pediatric orthopaedists' ability to responsibly treat postoperative pain while limiting the distribution of unneeded opioids. Level of Evidence: Level IV-quality improvement project.

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Patient-Reported Outcomes in Pain Management After Ambulatory Pediatric General and Urologic Surgery

Pace¹,

Mack²,

Gong³

et al. 2023

Journal of Pediatric Surgery

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Impact of an opioid stewardship program on opioid exposure for pediatric appendectomy postsurgical pain

Cited by 3 publications

References 5 publications

Opioid stewardship program implementation in rural and critical access hospitals in Arizona

Opioid stewardship program implementation in rural and critical access hospitals in Arizona

Tiered Guidelines in a Pediatric Orthopaedic Practice Reduce Opioids Prescribed at Discharge

Patient-Reported Outcomes in Pain Management After Ambulatory Pediatric General and Urologic Surgery

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