Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Int J Pediatr Otorhinolaryngol. 2022 Aug;159:111209. doi: 10.1016/j.ijporl.2022.111209. Epub 2022 Jun 12.
Opioid prescribing patterns after pediatric tonsillectomy are highly variable, and opioids may not improve pain control compared to over-the-counter pain relievers. We evaluated whether a standardized, opioid-sparing analgesic protocol effectively reduced opioid prescriptions without compromising patient outcomes.
A quality improvement project was initiated in July 2019 to standardize analgesic prescribing after hospital-based tonsillectomy with/without adenoidectomy. An electronic order set provided weight-based dosing and defaulted to non-opioid prescriptions (acetaminophen and ibuprofen). Patients ages 0-6 received non-opioid analgesics alone. Patients ages 7-18 received non-opioid analgesics as first-line pain control, and providers could manually add hydrocodone-acetaminophen for breakthrough pain. Opioid prescriptions and quantities were compared for 18 months of cases pre- versus post-standardization. Postoperative returns to the system were reviewed as a balancing measure.
From 2018 through 2020, 1817 cases were reviewed. The frequency of opioid prescriptions decreased significantly post-standardization, from 64.9% to 33.5% of cases (P < .001). Opioid prescribing for young children steadily decreased from over 50% to 2.4%. Protocol adherence improved over time; outlier prescriptions were eliminated. Opioid quantities per prescription decreased by 16.3 doses on average (P < .001), and variance decreased significantly post-standardization (P < .001). The incidence of returns to the system did not change (P = .33), including returns for pain or decreased intake (P = .28).
An age-based and weight-based analgesic protocol reduced post-tonsillectomy opioid prescriptions without a commensurate increase in returns for postoperative complaints. Standardized protocols can facilitate sustained changes in prescribing patterns and limit potentially unnecessary pediatric opioid exposure.
小儿扁桃体切除术后的阿片类药物处方模式差异很大，与非处方止痛药相比，阿片类药物可能并不能改善疼痛控制。我们评估了一种标准化、减少阿片类药物的镇痛方案是否能有效减少阿片类药物处方，而不影响患者的结局。
2019 年 7 月启动了一项质量改进项目，以标准化基于医院的扁桃体切除术（伴或不伴腺样体切除术）后的镇痛处方。电子医嘱集提供基于体重的剂量，并默认非阿片类药物处方（对乙酰氨基酚和布洛芬）。0-6 岁的患者单独接受非阿片类镇痛药。7-18 岁的患者接受非阿片类镇痛药作为一线疼痛控制药物，并且医务人员可以手动添加氢可酮-对乙酰氨基酚用于缓解突破性疼痛。在标准化前后的 18 个月内，比较了阿片类药物处方和数量。作为平衡措施，审查了术后返回系统的情况。
2018 年至 2020 年，共回顾了 1817 例病例。标准化后，阿片类药物处方的频率显著下降，从 64.9%降至 33.5%（P<.001）。年幼儿童的阿片类药物处方逐渐减少，从 50%以上降至 2.4%。随着时间的推移，方案的依从性有所提高；消除了异常处方。平均每张处方的阿片类药物剂量减少了 16.3 剂（P<.001），方差显著减小（P<.001）。系统返回的发生率没有变化（P=.33），包括因疼痛或摄入减少而返回（P=.28）。
基于年龄和体重的镇痛方案减少了扁桃体切除术后的阿片类药物处方，而术后投诉的返回率没有相应增加。标准化方案可以促进处方模式的持续改变，并限制儿童不必要的阿片类药物暴露。
