Implementation of an Opioid Weaning Protocol at a Tertiary Care Children's Hospital.

Abstract

Evaluate the implementation of a pharmacist-managed opioid weaning regimen and objective opioid withdrawal assessment tool in pediatric patients requiring an opioid wean. We hypothesized that this combination would be associated with a reduction in the wean duration and length of stay and decrease episodes of opioid withdrawal. Retrospective cohort study utilizing pediatric inpatients requiring an inpatient opioid medication wean. The study was conducted in 3 phases from chart review of patients admitted from 2012 to 2020: baseline preintervention (phase 1), pharmacist-managed weaning regimen (phase 2), and addition of an objective assessment tool, the Withdrawal Assessment Tool-1 (phase 3). Data collection included the total wean duration, total duration of hospital admission, and number of episodes of opioid withdrawal. The study included 115 patients with 36 patients in phases 1 and 3 and 43 patients in phase 2. Median age ranged from 0.46 to 0.84 years and the majority of children were males. No significant differences in patient characteristics such as age, weight, sex, and previous opioid exposure were found between phases. Length of stay, wean duration, and episodes of withdrawal with need for rescue dose all decreased significantly from phase 1 to phase 3. Use of a pharmacist-managed weaning regimen combined with the Withdrawal Assessment Tool-1 tool was associated with significantly shorter methadone weans and overall length of stay. This has implications for wide spread dissemination and standardization of this approach in tertiary care children's hospitals caring for patients after ICU admission.