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Reducing opioid utilization after appendectomy: A lesson in implementation of a multidisciplinary quality improvement
Kimberly K Somers1, Ruchi Amin1, Kathleen M Leack1
1Children's Hospital of Wisconsin and Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
Surgery Open Science
|August 6, 2020
Summary
A quality improvement project successfully reduced opioid use in children after laparoscopic appendectomy. Implementing ice packs, standardized pain scores, and a new order set decreased overall opioid consumption.
Area of Science:
- Pediatric Surgery
- Pain Management
- Quality Improvement
Background:
- Perioperative pain management after appendectomy can be a child's initial exposure to opioids.
- Assessing and refining pain medication prescribing practices is crucial for reducing unnecessary opioid use.
Purpose of the Study:
- To decrease unnecessary opioid use in pediatric patients undergoing laparoscopic appendectomy.
- To implement simple, targeted interventions to improve perioperative pain management.
Main Methods:
- A quality improvement project involving three key measures: ice packs, standardized pain scores, and a revised postoperative order set.
- Comparison of pre- and postimplementation opioid utilization in patients undergoing laparoscopic appendectomy for acute appendicitis.
Main Results:
- Statistically significant decreases in intravenous and enteral opioid administration were observed postimplementation.
- The number of opioid doses prescribed at discharge and the proportion of patients discharged with opioids were significantly reduced.
- High compliance rates were achieved for the implemented measures: ice packs (66.9%), pain scores (88%), and postoperative order set (94.7%).
Conclusions:
- A multidisciplinary approach assessing expectations and current practices effectively reduced overall opioid consumption.
- Targeted interventions can significantly improve perioperative pain management and decrease opioid reliance in pediatric appendectomy patients.
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