PRP106: Implementation of Standardized C/S Pain Management Orders to Decrease MMEs Used in In-Patient Setting and at Discharge
Lauren Piper, DO
Context: Opioids are used routinely and effectively for the treatment of acute severe pain following surgery, however, given the state of the opioid crisis in the U.S., all physicians have an obligation to prescribe opioids only when necessary. Much research has been done in the area of post-operative pain management resulting in increased evidence for a multimodal approach with the intent to both treat pain as well as decrease side effects related to opioid use. Family medicine physicians who provide maternity care have a unique opportunity to be involved in pain management for their patients. Objectives: Two primary objectives: 1) To determine whether the average morphine milligram equivalents (MME) in post-operative Cesarean delivery patients during the year following the implementation of the new pain management protocol is significantly less than that of baseline data prior to implementation of the new pain management protocol, and 2) To determine whether there is a significant decrease in the average morphine milligram equivalents prescribed at discharge before and after the implementation of the new protocol. Setting: Bronson Methodist Hospital (BMH), a 415-bed hospital with a Level 3 Neonatal Intensive Care Unit, located in Kalamazoo, Michigan. The Bronson BirthPlace delivers more than 4,000 infants annually. Population Studied: Approximately 200 randomly selected patients undergoing Cesarean delivery at Bronson Hospital will be included in the post-intervention analysis. Intervention: The standard Cesarean Section Postpartum Order set was changed to include a multi-modal approach to pain management, with less default reliance on narcotics. The order set includes pre-checked orders for non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. Orders for IV morphine, IV hydromorphone and PO oxycodone remain available but must be specifically prescribed. Outcomes to be Reported: 1) Total MME prescribed during in-hospital stay following Cesarean delivery before and after the implementation of the new order set; 2) Total MME prescribed at discharge following Cesarean delivery before and after the implementation of the new order set; 3) Total number of opioid-containing pills prescribed at discharge pre- and post-intervention. Maximum pain scores on each post-operative day will also be evaluated.