801: Association of inpatient postpartum opioid use with bedside nurse

Abstract

Patient, delivery and physician factors are known to impact postpartum (PP) opioid use. Our objective was to assess the association between nurse providing PP bedside care and opioid use. This is a secondary analysis of a retrospective study of all women who delivered at a single center (12/2015-11/2016). Data were obtained from inpatient and pharmacy records. Opioid use during the first 12-hour PP shift after delivery was determined, as was the assigned PP nurse. Patients whose nurse had < 50 patient-shifts over the study period were excluded. A high amount of opioid use was defined as morphine milligram equivalents (MME) > 90% (stratified by vaginal [VD] and cesarean deliveries [CD]). Hierarchical logistic regression models were used to identify the extent to which individual nurses were associated with MME >90%, by establishing one model in which the only covariate was nurse (Model 1), and assessing whether patient, delivery, and physician factors altered the observed association (Model 2). The nurse whose patients had the lowest frequency of high opioid use was used as the referent. Kendall rank correlation assessed rank changes between models. 4,933 women were included in the analysis. Of the 3,637 and 1,296 women who had a VD and CD, 17.2% and 15.5%, respectively, used MME >90%. As illustrated by the results of the logistic regression for VD with nurse as the only covariate (Figure 1A), patients cared for by 7 of 55 nurses were significantly more likely to use MME >90%. Despite adjustment for multiple covariates (Figure 1B), 5 of the 7 nurses remained significantly associated with higher use. In the CD cohort, patients cared for by 2 of the 48 nurses were significantly more likely to use MME >90% (Figure 1C, 1D). Moreover, the variation seen among nurses remained largely unchanged after adjustment, as illustrated by the high rank correlations (Table). There is significant variation in PP hospitalization opioid use associated with the PP nurse that is not explained by patient, delivery, or physician factors.View Large Image Figure ViewerDownload Hi-res image Download (PPT)