Reducing the Use of Opioids for Pediatric Patients with Supracondylar Humerus Fractures

Supracondylar humerus (SCH) fractures, the most common elbow injuries in children, often require surgical reduction and percutaneous pinning. Postoperative pain medication management varies considerably, ranging from over-the-counter analgesics to multiday opioid prescriptions. In response to the Ohio opioid epidemic, this quality improvement project focused on limiting discharge opioid prescriptions to five or fewer doses.

Orthopedic providers were surveyed on their opioid prescribing practices and given blinded peer-comparison feedback. All orthopedic prescribers were educated via e-mail or in person on the opioid dose guideline for this injury. Any outlying prescribers identified from monthly data queries were reeducated on the project's specific aim. Prescribing providers, patients, and their caregivers were instructed to schedule and alternate non-opioid analgesics postoperatively. When opioids were prescribed, education emphasized the use of this medication only for severely rated pain. Standardized discharge instructions for postoperative fracture care and pain management, as well as electronic medical record orders, were used to emphasize these pain management strategies.

The percentage of opioid prescriptions of less than or equal to five doses for surgically managed SCH fracture patients was successfully increased by approximately 60 percentage points; 45.5% of surgical SCH fracture patients were discharged without an opioid prescription. Postdischarge requests for additional pain therapy remained stable.

The implemented education changes for patients, families, and orthopedic providers at this facility have paved the way for a decline in opioid prescribing and use. Further reduction in opioid prescribing is anticipated, with the goal to translate these practices to other orthopedic diagnoses.