53: Evaluation of a quality improvement intervention to decrease post-cesarean opioid use across a multi-hospital system

Abstract

To determine the effect of an order-set change incorporating standing acetaminophen and nonsteroidal anti-inflammatory drug (NSAID) use on oral opioid consumption post-cesarean delivery across a multi- hospital system. We implemented a quality improvement intervention across a network of six hospitals comprised of two large tertiary care centers, two mid-sized community hospitals, and two small community hospitals. The network- wide electronic post-cesarean delivery order set was changed to alter the timing of acetaminophen and NSAID orders from as-needed to standing, and to optimize the dosage of these medications. As-needed opioid orders remained the same before and after the intervention. Using generalized linear regression models, we assessed the impact of this intervention on the average milligrams of morphine equivalent (MME) of oral opioids consumed per patient during the 8 months prior to the intervention and the 8 months following the intervention. We evaluated a total of 4666 women delivered via cesarean at 6 network hospitals. The two large tertiary care centers delivering a total of 1808 and 1254 patients, respectively, demonstrated a significant decrease in mean oral opioid consumption before and after the intervention (118.0 to 81.6 MME p<0.001, and 186.4 to 136.3 MME p=0.01). The four community hospitals delivering a total of 997, 480, 29 and 27 patients, respectively, showed no significant change in mean oral opioid consumption before and after the intervention (93.1 to 86.3 MME, p=0.66, 210.3 to 218.5 MME p=0.72, 55.5 to 63.1 MME p=0.77, and 50.0 to 23.7 MME p=0.06). There was a trend towards less opioid use post-intervention in the smallest community hospital. Order sets incorporating standing acetaminophen and NSAID use after cesarean is associated with decreased oral opioid consumption post-operatively in some settings. Our intervention was associated with the greatest impact in tertiary care centers where multiple initiatives have heightened awareness of the risks associated with opioid use.