From the Department of Surgery, University of Arkansas for Medical Sciences.
Department of Surgery, Arkansas Children's Hospital Research Institute.
J Patient Saf. 2024 Jun 1;20(4):299-305. doi: 10.1097/PTS.0000000000001209. Epub 2024 Jan 19.
Variability in opioid-prescribing practices after common pediatric surgical procedures at our institution prompted the development of opioid-prescribing guidelines that provided suggested dose limitations for narcotics. The aims of this study were to improve opioid prescription practices through implementation of the developed guidelines and to assess compliance and identify barriers preventing guideline utilization.
We conducted a single-center cohort study of all children who underwent the most common outpatient general surgery procedures at our institution from August 1, 2018, to February 1, 2020. We created guidelines designed to limit opioid prescription doses based on data obtained from standardized postoperative telephone interviews. Three 6-month periods were evaluated: before guideline implementation, after guideline initiation, and after addressing barriers to guideline compliance. Targeted interventions to increase compliance included modification of electronic medical record defaults and provider educations. Differences in opioid weight-based doses prescribed, filled, and taken, as well as protocol adherence between the 3 timeframes were evaluated.
A total of 1033 children underwent an outpatient procedure during the 1.5-year time frame. Phone call response rate was 72.22%. There was a significant sustained decrease in opioid doses prescribed ( P < 0.0001), prescriptions filled ( P = 0.009), and opioid doses taken ( P = 0.001) after implementation, without subsequent increase in reported pain on postoperative phone call ( P = 0.96). Protocol compliance significantly improved (62.39% versus 83.98%, P < 0.0001) after obstacles were addressed.
Implementation of a protocol limiting opioid prescribing after frequently performed pediatric general surgery procedures reduced opioids prescribed and taken postoperatively. Interventions that addressed barriers to application led to increased protocol compliance and sustained decreases in opioids prescribed and taken without a deleterious effect on pain control.
我们机构在常见儿科手术术后的阿片类药物处方实践存在差异，这促使我们制定了阿片类药物处方指南，为麻醉性镇痛药的剂量限制提供了建议。本研究的目的是通过实施制定的指南来改善阿片类药物的处方实践，并评估其依从性，确定阻碍指南实施的障碍。
我们对 2018 年 8 月 1 日至 2020 年 2 月 1 日期间在我们机构接受最常见门诊普外科手术的所有儿童进行了一项单中心队列研究。我们制定了基于标准化术后电话访谈数据的指南，旨在限制阿片类药物的处方剂量。评估了三个 6 个月的时间段：指南实施前、指南启动后和解决遵医行为障碍后。为提高依从性，我们采取了一些针对性的干预措施，包括修改电子病历默认设置和对医务人员进行教育。评估了三个时间框架内的阿片类药物基于体重的剂量、开具、服用以及方案遵守情况的差异。
在 1.5 年的时间里，共有 1033 名儿童接受了门诊手术。电话回复率为 72.22%。实施后，开具的阿片类药物剂量（P < 0.0001）、开具的处方（P = 0.009）和服用的阿片类药物剂量（P = 0.001）均呈持续显著下降，而术后电话随访中报告的疼痛无明显增加（P = 0.96）。在解决了障碍后，方案遵守情况显著改善（62.39%比 83.98%，P < 0.0001）。
在经常进行的儿科普通外科手术后实施限制阿片类药物处方的方案可减少术后开具和服用的阿片类药物。针对应用障碍的干预措施可提高方案的依从性，并持续减少开具和服用的阿片类药物，而不会对疼痛控制产生不利影响。
