A Retrospective Comparison of Intravenous Opioid Use for Abdominal Pain in the Emergency Department After Implementation of Order Set Restriction.

Abstract

This study was developed to provide insight into the effects of an i.v. opioid order set on prescribing of i.v. opioids in the emergency department (ED) for nontraumatic, unspecified abdominal pain. Research is needed in this area to catalyze more consistent and evidence-based i.v. opioid prescribing. This study aimed to show the impact of an i.v. opioid order set restriction. Secondary objectives were the change in ED length of stay, change in pain score, total i.v. opioid morphine milligram equivalents, and number of i.v. opioid doses. Patients included in the study visited the ED with a relevant ICD-10-CM diagnosis code for nontraumatic, unspecified abdominal pain 3 months prior to or 3 months after the restriction. A sample size of 596 patients was calculated for 80% power to identify a 25% difference in the primary outcome. There was a statistically significant decrease in i.v. opioid administration after the restriction (44.2% preintervention, 23.2% postintervention; p < 0.001). Mean length of stay decreased from 6.6 h to 6.2 h (p < 0.05). There was no statistically significant difference in pain scores. Oral opioid use increased significantly (20.5% preintervention, 31.7% postintervention; p < 0.001); therefore, combined i.v. and oral opioid use did not change significantly. The restriction correlated with a decrease in i.v. opioids. Pain control was not diminished as a result of the restriction. The results of this study may be used to generate hypotheses for comparing different modes of pain management in the ED in this patient population and others. Future studies should continue to evaluate the impact of oral vs. i.v. opioids.