期刊
CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE
卷 69, 期 8, 页码 1007-1016出版社
SPRINGER
DOI: 10.1007/s12630-021-02143-7
关键词
Narcotics; Cesarean delivery; Obstetrics; Analgesia; Opioids
资金
- Generalist Division, Department of Obstetrics and Gynaecology
- Department of Anesthesiology and Pain Medicine at Mount Sinai Hospital
After implementing a quality improvement bundle, opioid prescriptions at discharge following Cesarean delivery significantly decreased at Mount Sinai Hospital in Toronto. This decrease was sustained over the study period, and there were no visits to the postnatal assessment clinic for inadequate pain control.
Purpose To evaluate whether opioid prescriptions at discharge after Cesarean delivery decreased following implementation of a quality improvement bundle. Methods A quality improvement bundle was instituted at Mount Sinai Hospital in Toronto. Interventions included opioid prescribing instructions in resident orientation, nursing and patient education, and standard electronic prescriptions. We used an interrupted time series study design and included patients who had a Cesarean delivery six months pre intervention and six months post intervention. Primary outcome data (opioids prescribed at discharge in morphine milliequivalents [MME]), were aggregated (averaged) by calendar week and analyzed using interrupted time series. Secondary outcomes were assessed using bivariate methods and included opioid use for breakthrough pain in hospital, and amount of opioids prescribed by prescriber specialty and training level. Results We included 2,578 women in our analysis. Based on the segmented regression analysis, prescribed opioids decreased from 97.6 MME in 2018 to 35.8 MME in 2019 (difference in means, - 61.7; 95% confidence interval [CI], - 72.2 to - 51.3; P < 0.001), and this decrease was sustained over the study period. Post intervention, there were no visits to our postnatal assessment clinic for inadequate pain control. Conclusion A quality improvement bundle was associated with a marked and sustained decrease in discharge prescriptions of opioids post Cesarean delivery at a large Canadian tertiary academic hospital.
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