Standardising discharge post-surgical pain control: a quality improvement project

Area of Science:

• Cardiology
• Pain Management
• Public Health

Background:

• Opioid prescribing is a key factor in the ongoing opioid epidemic.
• Cardiac surgical patients represent a population where opioid prescribing can be optimized.
• A children's hospital identified a need to improve opioid prescribing practices.

Purpose of the Study:

• To standardize opioid prescribing practices for postoperative cardiac surgical patients.
• To reduce opioid prescriptions at discharge for this patient group.
• To improve pain management strategies in pediatric cardiac surgery.

Main Methods:

• A multidisciplinary team utilized the Model for Improvement framework.
• Key interventions included evidence-based prescribing guidelines, non-opioid pain management, and EHR integration.
• Data collected included guideline compliance, morphine equivalent dosing, opioid-free discharges, and length of stay.

Main Results:

• Guideline compliance increased from 24% to 100%.
• Morphine equivalent dosing at discharge decreased significantly, reaching 0 in 2022.
• Opioid-free discharges increased, reaching 0% in 2022, with no increase in length of stay.

Conclusions:

• Standardized, evidence-based guidelines effectively reduce opioid prescribing in pediatric cardiac surgery.
• Enhanced pain management with non-opioids and guideline integration are crucial for success.
• This approach improves patient outcomes and addresses the opioid epidemic at a local level.