Strategies to Reduce High-Dose Opioid Prescriptions at Discharge for Cesarean Section Patients
Addressing the opioid epidemic is paramount given its profound impact on individuals, families, and communities. Hudson Hospital and Clinic recognized this urgency and prioritized interventions to combat the crisis, aiming to reduce opioids dispensed for home use on discharge prescriptions, including for cesarean section patients, with Morphine Milligram Equivalent (MME) as the unit of measure.
A multidisciplinary team of doctors, pharmacists, and nurses assembled to revise pain control sections of order sets and staff education materials. This team collaborated to review prescribing practices, implement evidence-based changes, adjust order sets, and create educational materials promoting safer prescribing.
It became evident that effective pain control post-cesarean section necessitated a multifaceted approach, moving beyond sole reliance on opioids. Darla Klementz Pharm D, RPh, Director of Pharmacy emphasized this shift, stating, "We needed to depart from the idea that opioids alone provide incisional pain relief." Implementing a regimen of scheduled acetaminophen and NSAIDs alongside opioids as needed proved effective in pain management. Additionally, non-pharmacologic methods such as aromatherapy patches, massage, warm packs, ice packs, music therapy, and early ambulation were encouraged to complement pharmacological interventions.
When opioids are necessary to complement scheduled acetaminophen and NSAIDs, the approach begins with administering the lowest effective dose. Whitney Peterson, MSN, RN, Director of Women’s Center Services, highlights the misconception that higher opioid doses are necessary to manage pain preemptively. Instead, the emphasis is on initiating treatment with the lowest effective dose to prevent overmedication and enhance safety.
Discharge prescriptions are individualized by physicians to ensure adequate pain control during home recovery, considering the patient's unique needs and factoring in opioid use in the last 24 hours before discharge. This tailored approach promotes safer postpartum care and aligns with Hudson Hospital and Clinic's commitment to addressing the opioid crisis and fostering safer prescribing practices. These proactive measures contribute to improved patient outcomes and the overall well-being of the community.