Reducing the Use of Opioids in the Peripartum Period—A Quality Improvement Initiative [34E

Abstract

INTRODUCTION: The aim of this quality improvement initiative was to reduce the use of oral opioids in the inpatient postpartum period. METHODS: A systematic approach to pain management during the postpartum hospitalization was employed. A step-wise approach was implemented that included non-pharmacologic interventions, scheduled non-opioid pain medications, and oral opioids for breakthrough pain. Outcomes for the first 8 months were compared to baseline data from all patients delivered in 2017. RESULTS: In the vaginal delivery group 2889 patients were evaluated. The average number of opioid tablets taken was 0.53 per patient compared to 1.64 per patient in the baseline group, a 68% reduction. The average number of patients who received any opioid during their postpartum hospitalization was 12.4% compared to 33.6% in the baseline group, a 63% reduction. In the Cesarean section group 1162 patients were evaluated. The average number of opioid tablets taken was 6.5 per patient compared to 10.2 per patient in the baseline group, a 36% reduction. The average number of patients who received any opioid during their postpartum hospitalization was 78.4% compared to 95.3% in the baseline group, an 18% reduction. CONCLUSION: This quality improvement project evaluated a systematic approach to pain management in the postpartum period that includes a scheduled non-opioid pharmacologic, non-pharmacologic pain interventions, and oral opioids for breakthrough pain. The results demonstrate a clear reduction in oral opioid pain medication consumption during the postpartum hospitalization.