PM1064: Reducing Post-operative Opioids Prescribed on a Pediatric Surgery Service: An Educational Countermeasure Quality Initiative

Purpose/Objectives: A recent cross-sectional study at our children's hospital revealed that most patients received excess opioids at discharge after surgery and less than a quarter properly disposed of them. To reduce this pattern of opioid over-prescription and improper disposal, we aimed to apply an educational countermeasure at the time of discharge after surgery.

Design/Methods: Pilot study included pediatric patients who were discharged with postoperative opioid prescription by the general pediatric surgery team at a single institution. The intervention involved three educational videos, explaining proper opioid use, disposal, and postoperative pain management. Families were also provided a prepaid envelope and given the option to return unused opioids. Patients were surveyed on their opioid usage after discharge at the postoperative follow-up. The study was completed after the allotment of 50 envelopes were distributed (July 2019 to June 2020). A retrospective review from July 2018 to February 2022 of patients who had a general surgery procedure was conducted to evaluate the impact on prescription patterns using Kruskal-Wallis test. Opioid prescriptions were converted to oral morphine equivalent (milligram) per weight in kilogram (OME/kg). Regression analysis was used to examine the association between patient- and procedure-specific variables and whether opioids were prescribed and the amount of opioids prescribed. P< 0.05 was considered significant.

Results: 1697 operations were performed where the discharge service was the pediatric surgery team, of which 495 cases occurred during the intervention period. There was a statistically significant decrease in median OME/kg prescribed at discharge that was sustained after the intervention period [pre: 2.25 (IQR 1.25, 3.75), during: 1.875 (1.00, 3.75), post: 1.875 (.94, 2.81) with p=0.009]. The percentage of patients who were prescribed opioids remained unchanged [15.0% (pre), vs 16.0% (during), and 13.3% (post), p=0.42]. Longer cases and hospital length of stays were significantly associated with discharge opioid prescriptions (p < 0.001 and p=0.001) and higher amounts of OME/kg prescribed (p=0.002 and p=043). Spanish-speaking patients were prescribed a lower median OME/kg compared to English-speaking patients [1.9 (0.05-28.1) vs 1.3 (0.5-7.5)]; p=0.038). 23 of the 50 patients, who were provided envelopes, responded to the postoperative survey. The survey showed that 70% of respondents used less than half or none of their opioid prescriptions.

Conclusion/Discussion: Our study shows that by providing patient education around best practices, our institution has been able to decrease the amount of opioids prescribed. A potential disparity may exist in opioid prescribing practice that needs to be further explored. In addition, results from the survey suggest that there is still opportunity to further reduce opioid over-prescription.