Reducing Opioid Doses Prescribed From a Pediatric Emergency Department

Area of Science:

• Pediatric Emergency Medicine
• Public Health
• Quality Improvement Science

Background:

• Opioid overdose and abuse are at epidemic levels in the U.S., with medical prescriptions contributing significantly to misuse.
• Initiatives to curb opioid exposure from pediatric emergency departments (EDs) are crucial for public health.
• The study focused on reducing opioid prescribing in a pediatric ED setting.

Purpose of the Study:

• To reduce weekly opioid doses prescribed from a pediatric emergency department (ED) by 50% within four months.
• To evaluate the impact of a quality improvement initiative on opioid prescribing practices.
• To assess the safety and efficacy of reduced opioid prescribing on patient outcomes.

Main Methods:

• Implementation of interventions through Plan-Do-Study-Act cycles, including guidelines, education, EMR optimization, and provider feedback.
• Monitoring of primary measures: weekly opioid doses and doses per 100 ED visits.
• Tracking of process measures (prescriptions, doses per prescription) and balancing measures (return visits, poor pain control reports).

Main Results:

• Weekly opioid doses decreased by 91% (from 153 to 14 per week) and doses per 100 ED visits by 92% (from 8 to 0.7).
• Opioid prescriptions, doses per prescription, and prescriptions for common pediatric complaints (abdominal pain, headache, URI) all decreased.
• There was no increase in phone calls or return visits for poor pain control; only 2 reports of poor pain control were noted among 152 orthopedic patients.

Conclusions:

• A comprehensive quality improvement initiative successfully reduced opioid prescribing in a pediatric ED by 91%.
• The significant reduction in opioid doses was achieved without negatively impacting patient pain management or increasing healthcare utilization.
• These findings demonstrate the feasibility and effectiveness of targeted interventions to combat the pediatric opioid crisis.