828: Optimizing post-cesarean opioid prescription practices: a quality improvement initiative

Abstract

Optimal prescriptions practices of opioids in the post-cesarean period remain controversial. The primary aim of this initiative was to minimize unused prescription narcotic medication, with a goal of ≤ 4 leftover pills of 5mg oxycodone at postoperative day (POD) 14 without affecting pain or satisfaction measures. A prospective longitudinal quality improvement (QI) initiative starting in 2017 utilizing the DMAIC methodology. The measurement phase consisted of validated surveys administered via email or backup phone calls over 3 months, along with chart review to determine current institutional prescription practices and predictors of outpatient opioid use. Resulting recommendations were adopted, and 1 year later, all patients undergoing cesarean were surveyed for 3 months to determine the effectiveness of the intervention. The study was approved by the Department’s QI Committee. The response rate was 48%, with 50 of 101 patients completing surveys pre-intervention and 52 of 111 post-intervention. Pre-intervention, surplus medication was predicted (p< 0.05) only by the quantity of the opioid prescription. In addition, patients who required ≤ 37.5 morphine milligram equivalents (MME) during the inpatient postoperative stay did not require outpatient narcotic prescriptions. Thereafter, a strategy of matching inpatient use to outpatient prescription 1:1 in a linear regression model (p< 0.001, R2 0.55) optimally matched patient needs up to 200 MME. In the post-intervention survey (Table 1), mean (SD) prescription decreased from 17.6 (13.7) MME to 8.4 (8.3) MME (p< 0.01); 39% compared to 16% of women were discharged without a prescription (p< 0.01); and amongst all patients 82.7% compared to 59.6% (p< 0.01) had ≤ 4 pills remaining without differences in patient satisfaction or pain perception (Table 2). This initiative highlights a practical approach to QI utilizing industry techniques in healthcare. This approach resulted in significant reductions in over-prescription and unused medication; without impacting pain or satisfaction scores.View Large Image Figure ViewerDownload Hi-res image Download (PPT)