Division of Obstetric Anesthesia, Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
Am J Perinatol. 2024 May;41(S 01):e2934-e2940. doi: 10.1055/a-2184-0423. Epub 2023 Sep 29.
There are increasing efforts among health care systems to promote safe opioid prescribing; however, best practice for minimizing overprescription is not established. Our study aimed to evaluate the effect of a tailored opioid prescribing algorithm on opioid prescription quantities.
A tailored opioid prescribing algorithm was developed to provide a recommended prescription quantity based on inpatient opioid use. A retrospective analysis of opioid prescribing 3 months before and after implementation was performed. Our primary outcome was the number of oxycodone 5-mg tablets prescribed. Subgroup analysis by oxycodone consumption in the 24 hour prior to discharge was performed. Patient satisfaction and unused opioid tablets were assessed by text message survey 2 weeks' postpartum.
We included 627 ( = 313 preimplementation; = 314 postimplementation) patients who underwent cesarean delivery. Clinical characteristics were similar between groups. The median number of oxycodone 5-mg tablets prescribed in the baseline group was 20 (interquartile range [IQR]: 20-30), compared with 5 (IQR: 0-10) in the tailored prescribing group ( < 0.0001). For patients with no opioid use in the 24 hours prior to discharge, the median number of tablets prescribed decreased from 20 (IQR: 10-20) to 0 (IQR: 0-5) following the intervention ( < 0.0001). The proportion of patients discharged without an opioid prescription increased from 7% (23/313) in the baseline group to 35% (111/314) in the tailored prescribing group (odds ratio: 6.9, 95% confidence interval [4.3, 11.1]).
Tailored opioid prescribing reduced the number of opioid tablets prescribed and increased the proportion of patients who were discharged without an opioid prescription.
· Opioid prescribing should be tailored by inpatient use.. · Tailored prescribing reduced opioid prescription amounts.. · Many patients do not require an opioid prescription..
医疗保健系统越来越重视促进安全的阿片类药物处方；然而，尚未确定最小化过度处方的最佳实践。我们的研究旨在评估定制阿片类药物处方算法对阿片类药物处方数量的影响。
开发了一种定制的阿片类药物处方算法，根据住院患者的阿片类药物使用情况提供建议的处方数量。在实施前后进行了回顾性分析。我们的主要结果是开出的羟考酮 5 毫克片剂数量。根据出院前 24 小时内羟考酮的消耗量进行亚组分析。在产后 2 周通过短信调查评估患者满意度和未使用的阿片类药物片剂。
我们纳入了 627 名（基线组=313 名；实施组=314 名）接受剖宫产的患者。两组的临床特征相似。基线组开出的羟考酮 5 毫克片剂中位数为 20（四分位距[IQR]：20-30），而定制处方组为 5（IQR：0-10）（ <0.0001）。对于出院前 24 小时内没有使用阿片类药物的患者，干预后开出的片剂中位数从 20（IQR：10-20）减少到 0（IQR：0-5）（ <0.0001）。从基线组的 7%（23/313）增加到定制处方组的 35%（111/314）（优势比：6.9，95%置信区间[4.3,11.1]）没有开阿片类药物处方的患者比例增加。
定制阿片类药物处方减少了开出的阿片类药物片剂数量，并增加了没有开出阿片类药物处方的患者比例。
·阿片类药物的开具应根据住院使用情况进行调整。·定制开具减少了阿片类药物的处方量。·许多患者不需要阿片类药物处方。
