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Implementation of a Quality Improvement Initiative to Decrease Opioid Prescribing After Cesarean Delivery.

Malavika Prabhu1, Heloise Dubois, Kaitlyn James

  • 1Division of Maternal-Fetal Medicine, the Deborah Kelly Center for Outcomes Research, and the Division of Nurse-Midwifery, the Department of Obstetrics and Gynecology, and the Division of Obstetric Anesthesia, the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, and the Division of Obstetric Anesthesia, Department of Anesthesia, Critical Care, and Pain Medicine, and the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

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A quality improvement initiative significantly reduced opioid prescriptions after cesarean delivery by 35%. This involved counseling and shared decision-making, increasing acetaminophen use without affecting refill rates.

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Area of Science:

  • Obstetrics and Gynecology
  • Pain Management
  • Quality Improvement in Healthcare

Background:

  • Cesarean delivery often involves significant pain, leading to opioid prescriptions.
  • There's a need to optimize pain management strategies post-cesarean to reduce opioid dependence.

Purpose of the Study:

  • To evaluate a multiphase quality improvement program aimed at decreasing opioid prescribing after cesarean delivery.
  • To assess the impact on multimodal nonopioid analgesic use.

Main Methods:

  • Prospective quality improvement study involving two phases.
  • Phase 1: Provider counseling, shared decision-making, and reduced maximum opioid prescription (30 tablets).
  • Phase 2: Further reduced maximum opioid prescription to 25 tablets based on Phase 1 results.

Main Results:

  • A 35% overall reduction in opioid tablets prescribed post-cesarean delivery.
  • Mean opioid tablets decreased from 33.2 to 21.5 across study phases (P<.01).
  • Acetaminophen prescribing increased significantly (32.6% to 92.0%, P<.001), while ibuprofen rates remained high (>98%). Opioid refill rates were unaffected.

Conclusions:

  • A multiphase quality improvement protocol effectively reduced opioid prescribing after cesarean delivery.
  • Iterative adjustments and data review enhanced the protocol's success.
  • The strategy promoted nonopioid analgesic use alongside reduced opioid dispensing.