Medical University of South Carolina Department of Orthopaedics and Physical Medicine, Charleston, South Carolina.
Medical University of South Carolina Department of Orthopaedics and Physical Medicine, Charleston, South Carolina.
J Surg Educ. 2021 Sep-Oct;78(5):1660-1665. doi: 10.1016/j.jsurg.2021.03.005. Epub 2021 Apr 7.
To evaluate institutional opioid prescribing patterns following percutaneous fixation of pediatric supracondylar humerus fractures before and after implementation of a standardized discharge order set.
A retrospective review of patients who underwent closed reduction and percutaneous skeletal fixation of a Type II or III supracondylar humerus fracture in 2017 (prior to pain protocol implementation) and again in 2019 (after pain protocol implementation) SETTING: Single Tertiary Care Children's Hospital PARTICIPANTS: In total, 106 patients met inclusion criteria between years 2017 (n = 49) and 2019 (n = 57). Exclusion criteria included miscoded patients, open fractures, patients who presented with vascular injury or nerve palsy, polytrauma patients with multiple fractures in the same upper extremity, and supracondylar humerus fractures that underwent an open procedure.
There were no significant differences between inpatient pain scores (p = 0.91) and MDE prescribed (p = 0.75) between the 2 cohorts. In 2017, large variability was noted in day supply of opioids (0-11.4 days) and MDE (0-8.45 mg/kg), with significant differences between prescribing patterns of junior and senior level residents (mean day supply of opioids (p = 0.045), mean MDE prescribed on discharge (p = 0.001)). After implementation of a standardized opioid discharge order set, there was a tenfold increase in the number of patients discharged without an opioid prescription (2017: 4%, 2019: 44%). Additionally, any discrepancies between prescribing practices of junior and senior level residents were eliminated (mean day supply of opioids (p = 0.65), mean MDE prescribed on discharge (p = 0.69)).
The introduction of a standardized post-operative opioid discharge order set led to a 10-fold increase in the number of patients discharged without an opioid prescription. Additionally, the order set decreased the variability in the prescribing patterns of discharge opioid medications without change in pain control. The resident prescribing variability based upon level of experience resolved with the use of the order set.
评估在实施标准化出院医嘱集前后，经皮固定儿童髁上肱骨骨折后机构阿片类药物处方模式。
回顾性分析 2017 年（疼痛方案实施前）和 2019 年（疼痛方案实施后）接受闭合复位和经皮骨骼固定 II 型或 III 型髁上肱骨骨折的患者。
单家三级儿童保健医院。
共有 106 名患者符合 2017 年（n=49）和 2019 年（n=57）纳入标准。排除标准包括编码错误的患者、开放性骨折、出现血管损伤或神经麻痹的患者、同一上肢多处骨折的多发伤患者，以及接受开放手术的髁上肱骨骨折患者。
两组患者的住院疼痛评分（p=0.91）和 MDE 处方（p=0.75）无显著差异。2017 年，阿片类药物的日供应量（0-11.4 天）和 MDE（0-8.45mg/kg）差异较大，初级和高级住院医师的处方模式存在显著差异（阿片类药物的平均日供应量（p=0.045），出院时 MDE 的平均处方量（p=0.001））。在实施标准化阿片类药物出院医嘱集后，无需阿片类药物处方出院的患者数量增加了 10 倍（2017 年：4%，2019 年：44%）。此外，初级和高级住院医师之间的任何用药差异都消除了（阿片类药物的平均日供应量（p=0.65），出院时 MDE 的平均处方量（p=0.69））。
引入标准化术后阿片类药物出院医嘱集后，无需阿片类药物处方出院的患者数量增加了 10 倍。此外，该医嘱集减少了出院阿片类药物处方的变异性，而不会影响疼痛控制。使用该医嘱集解决了基于经验水平的住院医师处方变异性问题。
