(431) An individualized prescribing protocol for opioid prescriptions at hospital discharge after cesarean delivery

Thursday, February 9, 2023

4:00 PM – 5:30 PM

Objective: To decrease morphine milligram equivalents (MME) prescribed at hospital discharge after cesarean delivery with the initiation of an individualized prescription protocol.

Study Design: This is a prospective cohort study of patients undergoing cesarean delivery before and after implementation of an individualized opioid prescribing practice at time of hospital discharge. Each patient was prescribed scheduled ibuprofen and acetaminophen, with a prescription for oxycodone tablets equal to 5 times the MME used in the 24 hours prior to discharge, calculated via an electronic order set (Figure 1). The prior traditional cohort were routinely prescribed 30 tablets of acetaminophen-codeine. The primary outcome was MME prescribed at discharge. A hotline to address pain control issues after discharge was established and calls, ER visits, and re-admissions were examined. Patients with history of opioid use disorder were excluded. Statistical analyses included chi-square and Wilcoxon rank-sum.

Results: 412 women underwent cesarean delivery in the 6 weeks after initiation of the individualized prescribing protocol, and were compared to 367 women prior to the change. The median MME prescribed at discharge was lower with individualized prescribing (37.5 vs 135 MME, P < 0.001, Table). 176 (43%) women were not prescribed opioids at discharge which was a substantial change as all 367 women in the traditional cohort received opioids at discharge (P < 0.001, Table). Nine hotline phone calls were received; none required additional opioids after a 24 hour trial of scheduled ibuprofen, which none had taken prior to the call. 11 (2.7%) patients presented to the emergency room for pain evaluation, of which none required re-admission or an outpatient prescription of opioids.

Conclusion: An individualized protocol for opioid prescriptions after cesarean delivery decreased total MME and number of opioid tablets at discharge, without hospital re-admissions or need for rescue opioid prescriptions after discharge. Opioids released into our community will be reduced by 90,000 tablets per year, without demonstrable adverse effect.

Primary & Presenting Author(s)

Chinonye S. Imo, MD (she/her/hers)
Chinonye Imo
UT Southwestern Medical Center
Dallas, Texas, United States

Coauthor(s)

DM
Devin A. Macias, MD
UT Southwestern Medical Center
Dallas, Texas, United States
DM
Donald D. McIntire, PhD
University of Texas Southwestern Medical Center
Dallas, Texas, United States
JM
Jennifer McGuire, Pharm D
Parkland Health
Dallas, Texas, United States
David B. Nelson, MD
Associate Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Elaine L. Duryea, MD
Assistant Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States