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Tiered Guidelines in a Pediatric Orthopaedic Practice Reduce Opioids Prescribed at Discharge

Courtney E Baker1, A Noelle Larson1, Daniel S Ubl2

  • 1Department of Orthopedic Surgery, Mayo Clinic.

Journal of Pediatric Orthopedics
|September 24, 2021
PubMed

Insights

Implementing tiered guidelines significantly reduced opioid prescriptions for pediatric orthopedic surgery patients. Adherence was high, with no increase in refill rates, promoting responsible pain management.

Area of Science:

  • Orthopaedic Surgery
  • Pain Management
  • Quality Improvement

Background:

  • Limited data exists on opioid prescribing after pediatric orthopaedic procedures.
  • Opioid overprescription is a significant concern in pediatric care.

Purpose of the Study:

  • To evaluate the impact of tiered guidelines on discharge opioid prescriptions.
  • To assess adherence to guidelines and changes in opioid refill rates.

Main Methods:

  • A quality improvement project at an academic institution.
  • Implementation of 4-tiered guidelines for 28 common pediatric orthopaedic procedures.
  • Comparison of pre-guideline (2017) and post-guideline (2019) cohorts.

Main Results:

  • Significant decrease in median oral morphine equivalents (OMEs) prescribed (97.5 to 37.5).
  • Increased rate of no opioids prescribed at discharge (13% to 23%).
  • High adherence (91%) to guidelines with reduced prescription variability.

Conclusions:

  • Tiered guidelines effectively reduce opioid quantities prescribed post-pediatric orthopaedic surgery.
  • Guidelines improve responsible opioid prescribing and limit unnecessary opioid distribution.
  • No significant increase in 30-day opioid refill rates observed.
Abstract

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