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

Baker, Claire; Larson, A. Noelle; Ubl, Daniel S.; Shaughnessy, William J.; Rutledge, John D; Stans, Anthony A.; Habermann, Elizabeth B.; Milbrandt, Todd A.

doi:10.1097/bpo.0000000000001974

Cited by 8 publications

(3 citation statements)

References 31 publications

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“…One single-institution pediatric opioid prescribing guideline implemented by Jones et al 20 for orthopaedic patients achieved a 54% reduction in prescribed opioids. Likewise, Baker et al 28 demonstrated decreased opioid prescribing variability associated with a 4-tier discharge opioid prescribing guideline. We recommend orthopaedic surgeons utilize evidence-based data such as these, or the results of their own experience monitoring medication consumption to achieve similar reductions in opioid prescribing.…”

Section: Discussionmentioning

confidence: 99%

Opioid Use in Pediatric Patients After Common Orthopaedic Surgeries

Perkins

Murata

Kim

et al. 2023

Journal of Pediatric Orthopaedics

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Background: The use and misuse of opioid medications is an epidemic and public health emergency. There are currently no standard guidelines for treating perioperative pain in the pediatric population. The purpose of this study is to describe opioid use among pediatric patients after common orthopaedic surgeries. Methods: Patients between 5 and 20 years of age undergoing one of 7 common orthopaedic surgeries between the years 2018 to 2020 were prospectively studied. Patients and their families completed a medication logbook to track all doses of pain medication and associated pain scores. Results: Three hundred forty-two patients completed the study, including 174 females and 168 males with a mean age of 14.0 years (range, 5 to 20 y). A total of 4351 tablets or liquid doses of the narcotic medication, 44% of the total prescribed, were consumed. Of the prescribed medication,56% remained unused. Nonsteroidal anti-inflammatory drug use was identified to be the only independent predictor of less narcotic use, with a mean of 5.1 tablets (P = 0.003) and 1.7 days (P < 0.01) less opioid consumed among these patients. Thirty-two (9.4%) patients consumed 100% of their prescriptions. Nonmedicinal methods of pain control, most commonly ice, were used by 77% of patients, and this was highly variable between procedures. Physicians were cited as a source of medication information by only 50% of patients, with high variability between procedures. Conclusions: Opioid medication use in children and adolescents after orthopaedic surgery is significantly less than the number of tablets prescribed, with 56% of the medication prescribed remaining unused in the postoperative period. Duration of narcotic use was longer than anticipated with a wide SD (4.7 d +/−3 d). We recommend orthopaedic surgeons responsibly prescribe pain medications using evidence-based data or the results of their own experience monitoring medication consumption. In addition, and important in the setting of the “opioid epidemic,” physicians must counsel patients and families on postoperative pain expectations and appropriate medication use. Level of Evidence: Level IV, prospective case series.

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Section: Discussionmentioning

confidence: 99%

Opioid Use in Pediatric Patients After Common Orthopaedic Surgeries

Perkins

Murata

Kim

et al. 2023

Journal of Pediatric Orthopaedics

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“…In another randomized trial, Vincent et al highlighted again that patient education reduced the number and duration of pills taken, but there is still a grave overprescription of opioids, as they reported that approximately 50% of prescribed pills went unused 75 . Additional methods to reduce pills in circulation may be handouts on proper pill disposal 76 , tiered prescribing guidelines based on procedure type 77,78 , and prescriptions written in 3 equal distributions 79 .…”

Section: Practice Managementmentioning

confidence: 99%

What’s New in Hand and Wrist Surgery

Bohn

2023

Journal of Bone and Joint Surgery

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“…4 Many institutions are taking steps to optimize analgesia regimens to limit opioid prescriptions for an array of procedures. 5,6 Other groups have focused on demonstrating the efficacy of non-opioid pain medication, with three randomized control trials showing non-opioid pain medication to be as effective as opioids when treating extremity injury pain in children. [7][8][9] Non-opioid pain management following closed reduction and percutaneous pinning (CRPP) for Gartland Type II and III supracondylar humerus (SCH) fractures has become an area of focus within pediatric orthopaedics.…”

Section: Introductionmentioning

confidence: 99%

A Quality Improvement Initiative to Reduce Opioid Prescriptions Following Surgical Treatment of Supracondylar Humerus Fractures in Children

Rupp¹,

Langner²,

Manhard³

et al. 2023

Journal of the Pediatric Orthopaedic Society of North America

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Background: Opioid abuse and overdose are in epidemic range in the United States and medical prescriptions, including those for postoperative analgesia, are a large contributing source to this misuse. Our quality improvement initiative aimed to reduce the opioid prescribing of pediatric orthopaedic surgeons in the postoperative setting. The aim was to decrease the percentage of children with surgically treated supracondylar humerus (SCH) fractures who are prescribed opioid medications at discharge from a baseline of 40% to 10% within 6 months. Setting/Local Problem: The study took place at an urban level 1 trauma center at a children’s hospital. The orthopaedic team completed closed reduction and percutaneous pinning for SCH fractures over a 14-month baseline period. Forty percent of these patients were discharged with an opioid prescription. After assessing baseline prescription rates, a multidisciplinary team of health professionals developed a key driver diagram. Interventions: Primary interventions included orthopedic department-wide pain management education, reporting of prescription rates during monthly conferences, and provider-specific feedback. The primary measure was the percentage of patients prescribed opioids upon discharge following closed reduction and percutaneous pinning of Type II and III SCH fractures. As a balancing measure, we tracked the use of a 24-hour nurse triage line for pain-related follow-up in the intervention period. We used statistical process control to examine changes in measures over time. Results: The percentage of patients receiving opioid prescriptions upon discharge following surgically treated SCH fractures decreased from 40% to 8% over 5 months and sustained for an additional 16 months. Conclusions: Through provider education, feedback, and regular reporting, we decreased the number of pediatric patients with surgically treated SCH fractures that were discharged with any opioid prescription by 80% over 5 months while ensuring clinically adequate pain control.

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

Cited by 8 publications

References 31 publications

Opioid Use in Pediatric Patients After Common Orthopaedic Surgeries

Opioid Use in Pediatric Patients After Common Orthopaedic Surgeries

What’s New in Hand and Wrist Surgery

A Quality Improvement Initiative to Reduce Opioid Prescriptions Following Surgical Treatment of Supracondylar Humerus Fractures in Children

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