Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY; Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY.
Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY.
Am J Obstet Gynecol MFM. 2019 Nov;1(4):100049. doi: 10.1016/j.ajogmf.2019.100049. Epub 2019 Sep 27.
Cesarean delivery is the most common laparotomy performed in the United States and can be the first exposure to opioids for many women. Unnecessary consumption of opioids may lead to long-term addiction and further perpetuate this national health crisis.
The primary objective of the study was to assess whether a quality improvement initiative by means of a restrictive opioid prescription policy decreases opioid consumption and maintains patient satisfaction after cesarean delivery. A secondary objective is to correlate opioid consumption with demographic and perioperative factors.
A Plan, Do, Check, Act model was used to implement a quality improvement initiative. A restrictive opioid prescribing policy was put in place in July 2017 preventing all physicians from prescribing opioids to their patients upon discharge after cesarean delivery; patients could call their providers from home to request additional analgesia (opioid or nonopioid) if pain was not sufficiently controlled. From August 2017 to February 2018, a postdischarge telephone interview assessing pain control satisfaction and opioid consumption was conducted for all English-speaking patients in our hospital who underwent a cesarean delivery. Statistical analysis was performed using IBM SPSS 22.0, with P < .05 reported as statistically significant.
A total of 283 parturients were interviewed 8-33 days after cesarean delivery (mean, 16 days). After implementation of the restrictive opioid prescription policy, we observed a decrease in opioid prescriptions at discharge after cesarean delivery from 97.9% to 0%, with an 18% prescription rate after discharge. Patients reported high satisfaction with their pain control, with 89% (n = 253) stating that their pain was adequately controlled upon discharge. Although 90% (n = 256) reported that they did not need any pain medication other than ibuprofen or acetaminophen, opioids were prescribed to 18% of patients (n = 51) after discharge, with only 51% of these women (n = 27) consuming them. In response to the restrictive opioid prescribing policy, only 13% of the women (n = 37) reported that they wished that a stronger pain medication had been prescribed after hospital discharge. Factors associated with opioid consumption postdischarge included white race/ethnicity, multiparity, and opioid consumption during inpatient hospitalization.
Following implementation of the restrictive opioid prescribing policy, most women experienced adequate pain control after cesarean delivery. Patient satisfaction with pain control was high, showing that it is feasible to implement restrictive opioid prescription policies while maintaining a high satisfaction rate.
剖宫产术是美国最常见的剖腹手术，许多女性可能会首次接触到阿片类药物。不必要的阿片类药物消耗可能导致长期成瘾，并进一步加剧这一国家健康危机。
本研究的主要目的是评估通过限制阿片类药物处方政策来减少剖宫产术后阿片类药物消耗并维持患者满意度的质量改进计划是否有效。次要目的是将阿片类药物消耗与人口统计学和围手术期因素相关联。
采用计划、执行、检查、行动模型实施质量改进计划。2017 年 7 月，实施了一项限制阿片类药物处方的政策，禁止所有医生在患者行剖宫产术后出院时为其开具阿片类药物；如果疼痛未得到充分控制，患者可以从家中致电其提供者要求额外的镇痛（阿片类药物或非阿片类药物）。2017 年 8 月至 2018 年 2 月，对所有在我院行剖宫产术的英语患者进行了出院后电话采访，评估疼痛控制满意度和阿片类药物消耗情况。使用 IBM SPSS 22.0 进行统计分析，报告 P<0.05 为统计学显著。
共有 283 名产妇在剖宫产术后 8-33 天（平均 16 天）接受了采访。实施限制阿片类药物处方政策后，我们观察到剖宫产术后出院时阿片类药物处方率从 97.9%降至 0%，出院后处方率为 18%。患者对疼痛控制的满意度很高，89%（n=253）表示出院时疼痛得到充分控制。尽管 90%（n=256）报告除布洛芬或对乙酰氨基酚外，不需要任何其他止痛药，但仍有 18%（n=51）的患者出院后开具了阿片类药物，其中只有 51%（n=27）的患者服用了这些药物。针对限制阿片类药物处方政策，只有 13%（n=37）的女性表示希望出院后开具更强效的止痛药。出院后阿片类药物消耗的相关因素包括白人种族/民族、多胎妊娠和住院期间阿片类药物消耗。
实施限制阿片类药物处方政策后，大多数女性在剖宫产术后经历了足够的疼痛控制。患者对疼痛控制的满意度很高，表明在保持高满意度的同时，实施限制阿片类药物处方政策是可行的。
