812 Standardization of Burn Pain Control in the Outpatient Burn Population

Abstract

Abstract Introduction Nationwide there is a recognized need for regulation and standardization of prescription opioids for acute pain due to the opioid epidemic. Limited data exists about standardization of burn pain treatment in the outpatient setting; however, there are various treatment plans and minimal regulation of opioid prescriptions. The purpose of this study was to create a method of standardization of burn pain treatment and prescription of opioids for the burn outpatient. Methods A retrospective chart review was performed analyzing burn outpatient pain control regimens and indications for prescription opioids at a verified burn center. Factors such as burn size (TBSA), anatomical location, hospital length of stay, procedural sedation use, past medical history, surgical intervention, time since surgery, and psych history or elevated depression score were examined to create an objective scorecard. From the collected data, a treatment tier was created using ibuprofen and acetaminophen alternation as baseline pain control. The second and third tiers added oxycodone in increasing frequency for breakthrough of severe pain. Two exceptions were created for active cellulitis and a burn presenting in the first 12 hours since injury. Remaining unused opioid doses were also reviewed. Results Preliminary data collected from a 3 month trial demonstrated no significant change in the amount of opioids prescribed. There were 136 patients treated by burn advanced practice providers and the scorecard was used on 68 patients. On average, 7 opioid unused doses were remaining. Data using the current scorecard continues to be collected in the outpatient burn population. Conclusions Initial results conclude that there was no significant change in the amount of opioids prescribed but compliance was found to be a limiting factor in the data, as the scorecard was only used in 50% of the patients treated by the burn advance practice providers. Additional studies are needed to quantify improved compliance, patient satisfaction and increase in patient education on the treatment of pain. Applicability of Research to Practice A pain medication tool to standardize pain treatment for the outpatient may be valuable in burn centers.