Author(s)
Abbey Studer, MBA1
Kathleen Billings, MD2
Dana Thompson, MD, MS2
Jonathan Ida, MD2
Jeff Rastatter, MD2
Manisha Patel, RN, BSN, MSHI1
Patricia Huetteman, BS3
Erin Hoeman, MSN, APN, CPNP-PC4
Sarah Duggan, MSN, APN, CPNP-PC4
Sukhraj Mudahar, PharmD, BCPS5
Patrick Birmingham, MD4
Michael King, MD4
Jennifer Lavin, MD, MS2
Affiliation(s)
1Center for Excellence, Ann & Robert H Lurie Children's Hosp. of Chicago, Chicago, IL, 2Division of Pediatric Otolaryngology, Ann & Robert H Lurie Children's Hosp. of Chicago, Chicago, IL, 3Data Analytics and Reporting, Ann & Robert H Lurie Children's Hosp. of Chicago, Chicago, IL, 4Department of Anesthesia, Ann & Robert H Lurie Children's Hosp. of Chicago, Chicago, IL, 5Department of Pharmacy, Ann & Robert H Lurie Children's Hosp. of Chicago, Chicago, IL.;
Abstract:
Introduction: Divergent opinions regarding opioid use have been associated with unwarranted variation in postoperative pain management protocols in our academic pediatric otolaryngology division. This variation risks inconsistent messaging to families with resultant lack of clarity in pain management plan. Our aim was to produce a sustained reduction in opioid prescriptions in patients under age 5 through utilizing educational interventions, standardized algorithms, and electronic health record (EHR) automation tools.
Methods: Plan-do-study-act (PDSA) methodology was used to design and implement iterative interventions. First, a grand-rounds lecture was given on opioids and post-tonsillectomy pain control. Next, a multidisciplinary team created an age-based postoperative pain regimen in which patients under 5 years received non-opioid pain regimens. Finally, standardized discharge instructions and automated, age-specific order sets were created in the EHR to facilitate algorithm adherence. Rate of discharge opioid prescription was monitored and balanced against post-discharge opioid prescriptions and returns to the emergency department.
Results: At baseline, 66% of patients under 5 received opioid prescriptions. After the educational intervention, this decreased to 31%. Further reduction in prescription rates to 18% and 7% was noted after pain-regimen consensus and EHR order set implementation respectively. Requests for outpatient opioid prescriptions did not increase, and there was no significant change in returns to the emergency department (ED) for pain or in opioids prescribed in the ED.
Conclusion: Iterative cycles of improvement methodology utilizing educational interventions, standardized pain management protocols, and EHR tools are effective means of producing a sustained reduction in opioid prescription in the post-tonsillectomy population. Such findings suggest a framework for similar interventions in other pediatric otolaryngology settings.