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Published on: November 9, 2016
Discharge narcotic prescribing and management practices at pediatric trauma centers in the United States
Shiliang Alice Cao1, Kristina Monteiro2, Hale Wills3
1Primary Care-Population Medicine, Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, U.S.A. 02903; Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, U.S.A. 02903.
Insights
Pediatric trauma centers lack standardized narcotic education and prescribing practices. This highlights a critical need for improved pain management protocols to address risks associated with pediatric opioid use.
Area of Science:
- Pediatric Trauma Care
- Pain Management
- Public Health
Background:
- Trauma is a leading cause of death in US children.
- Narcotic pain medications are frequently used in pediatric trauma care.
- Significant risks are associated with narcotic use, yet knowledge on education and prescribing is limited.
Purpose of the Study:
- To investigate current narcotic education, prescribing practices, and pain management training at pediatric trauma centers.
- To assess the level of standardization in these practices nationwide.
Main Methods:
- A national cross-sectional survey was conducted among medical directors at pediatric trauma centers.
- Data were collected over six months on discharge narcotic education and prescribing practices.
Main Results:
- Narcotics are commonly prescribed by residents (79.1%) via Electronic Medical Records (EMR) (89.2%).
- Standardized narcotic education is rare (9.7%), and few EMRs recommend naloxone prescription (1.75%).
- Most staff lack training in non-pharmacological pain management (68.8%), and formal processes to reduce discharge narcotic quantities are absent (71.0%).
Conclusions:
- Significant lack of standardization exists in discharge narcotic education and prescription practices across US pediatric trauma facilities.
- There is a critical need for standardized narcotic prescribing and management protocols.
- Communication and system barriers hinder adequate narcotic education delivery, despite concerns about child opioid misuse.
Introduction:
Trauma is the leading cause of mortality among children in the US. Injured children often receive narcotic pain medication throughout their hospital stays and upon discharge from pediatric trauma centers. While effective, narcotics carry significant risks. There is a dearth of knowledge regarding narcotic education, prescribing practices, and pain management training at pediatric trauma centers. We hypothesize that there is a lack of standardization in these practices among pediatric trauma centers nationally.
Methods:
A national survey was sent to medical directors at ACS-verified and state designated level 1 and 2 pediatric trauma centers. Data were collected over 6 months on discharge narcotic education and prescribing practices.
Results:
Of 97 surveys sent, 92 were returned (94.8% response). Responses show that narcotics are most commonly prescribed by residents (79.1%). Electronic Medical Record (EMR) prescribing is common (89.2%); however, only 1.75% of EMRs give recommendation to prescribe naloxone. Only 9.7% report a standardized format of narcotic education. Most healthcare staff providing narcotic education receive no training in nonpharmacological pain management (68.8%). Most centers report no formal process to reduce the quantity of discharge narcotics prescribed (71.0%). Respondents report many barriers to providing discharge narcotic education to patients and families, including staff training on how to provide discharge narcotic education, staff availability, patient/ parent literacy, and format of available educational resources.
Conclusion:
The study results show that there is lack of standardization in discharge narcotic education and prescription practices among pediatric trauma facilities nationally and highlight the need for a standardized narcotic prescribing and management protocol. Despite the growing national concern of opiate misuse, particularly among children, respondents report inability to deliver adequate narcotic education owing to various communication and systems barriers.
Type Of Study:
Cross-sectional survey.
Level Of Evidence:
Level IV.
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