S3205 Development, Testing, and Implementation of an Opioid-Sparing Proactive Pain Control Order Set for Hospitalized Adults With IBD

Abstract

INTRODUCTION: In patients with inflammatory bowel disease (IBD), opioid-use is associated with an increased risk of poor quality of life, infection and death, yet opioids remain commonly prescribed. Many patients are first exposed to opioids during a hospitalization and continue them after hospital discharge. Therefore, opioid reduction strategies in hospitalized patients with IBD are desirable. We aimed to develop an opioid-sparing pain control strategy for hospitalized adults with IBD. METHODS: We conducted a systematic literature review and presented it to a panel of pharmacists, IBD specialists, and pain specialists to identify non-opioid medication regimens for pain in IBD. The panel iteratively developed an algorithm for scheduled and as-needed therapies to treat mild, moderate, and severe pain in patients with IBD. This protocol was used in a limited number of patients to assess feasibility and obtain patient feedback. Based on feedback, small changes were made. The final algorithm was presented to the pharmacy & therapeutics committee, and programmed as a 1-click order set within the electronic health record (Epic®). RESULTS: We developed an algorithm that includes scheduled acetaminophen, celecoxib, gabapentin, and as-needed lorazepam and hydromorphone tailored to mild, moderate and severe pain (Table 1). This algorithm was accepted and approved by a multidisciplinary therapeutics committee, and developed into a single-click electronic order set. CONCLUSION: We developed an evidence-based opioid-sparing algorithm for pain control in hospitalized patients with IBD. This proactive approach using scheduled non-opioid pain medications and as-needed opiates has the potential to both improve pain and reduce opioid use in the hospital. Testing of this proactive algorithm against usual care in a randomized, controlled trial is warranted.Table 1.: Proactive Inpatient Narcotic-Sparing Protocol