867 Standardized order sets do not eliminate racial/ethnic inequities in postpartum pain evaluation and management

Abstract

To quantify the extent to which a standardized pain management order set reduced racial/ethnic inequities in post-Cesarean pain evaluation and treatment. A follow-up retrospective cohort study comparing previously reported racial/ethnic inequities in post-Cesarean pain management (baseline period: 07/01/14–06/30/16) to data after implementation of a standardized pain management order set (03/01/17–02/28/18). Medical records were queried for number of pain assessments; pain scores> 7; scheduled non-opiate doses, and as needed opiate doses (converted to 5mg oxycodone tablet equivalents, OTE). Outcomes were grouped into 0-< 24 and 24-48 hours postpartum, and stratified by race/ethnicity (Hispanic, non-Hispanic Black (NHB), non-Hispanic White (NHW), Asian, and other). Analyses included logistic regression for the categorical outcome of pain score> 7 (severe pain), and linear regression. Main effect and interaction terms were used to calculate the difference-in-difference from baseline to follow-up. Before order set implementation (N=1701), we demonstrated NHW women had lower pain scores, more frequent pain assessments, and received more opiates than NHB women (% pain scores> 7 NHW/NHB 0-< 24h: 20%/28%; 24-48h: 25%/37%). After implementation (N=888), severe pain remained more common among NHB women (% pain scores> 7 NHW/NHB 0-< 24h: 23%/31%; 24-48h: 26%/38%). Pain management processes changed after implementation (Table), with overall fewer assessments, less opiates and more non-opiate analgesics. However, racial/ethnic inequities in number of assessments and treatment were unchanged (Table, all p for interaction > 0.05), with the exception of an increase in NSAID doses 24-48 hours postpartum for Hispanic women. A standardized pain management order set reduced overall postpartum opiate use, but did not reduce racial/ethnic inequities in pain evaluation and treatment. Future work should investigate racial equity-focused education and interventions designed to eliminate inequities in pain management.View Large Image Figure ViewerDownload Hi-res image Download (PPT)