Special Note: Many WHA members proud of their quality improvement efforts had prepared special poster presentations that were to be displayed in the Capitol Rotunda during WHA’s Advocacy Day 2020, which was cancelled due to the COVID-19 pandemic. Children’s Wisconsin prepared two separate poster presentations – you can see the other presentation in last week’s The Valued Voice
. WHA is pleased to highlight these efforts in today’s and future editions of The Valued Voice
.
In an effort to decrease the use of post-operative opioids in children undergoing appendectomies, Children’s Wisconsin’s Department of Pediatric Surgery began a quality initiative improvement project in 2017.
For many children, perioperative care after an appendectomy may be their first exposure to opioids. This quality improvement project was implemented to assess current practice of prescribing pain medications after an appendectomy to decrease unnecessary opioid use via simple, targeted steps. A Plan-Do-Study-Act (PDSA) methodology was used to determine the best interventions to improve opioid use after appendectomies. These interventions included the use of ice packs in the post-anesthesia care unit, documenting pain scores within 30 minutes of return to the hospital bed postoperatively, and using a standard order set for care with scheduled non-opioids like Tylenol and Ibuprofen.
After the completion of the PDSA cycles, there was a 93% decrease in intravenous use of opioids and a 54% decrease in the use of oral opioids while in the health care system. Overall, the total number of prescribed doses of opioids decreased from a median of 17 doses to 11 doses. A period of sustainment and monitoring occurred over an 18-month period. Outcomes were notable for compliance of greater than 99% use of the standard order set, 96% reduction in intravenous opioid use, and greater than 67% reduction in oral opioids. At discharge, the total number of opioid prescriptions decreased by greater than 58% with only 54% of the prescriptions being filled at a pharmacy. The total number of opioid doses was reduced by greater than 79%.
Given the success of the quality initiative, Pediatric Surgery has expanded the goals to use scheduled Tylenol and Ibuprofen for at least 48 hours, use opioids only in the immediate post-operative period and prescribe only three to five doses of opioids if a prescription is needed at discharge. Another 2020 goal is to leverage the electronic medical record for prescriptions that may need to be provided after discharge, using electronic prescribing to eliminate the “just in case” prescriptions that were being provided at discharge.
See poster here.
Attribute to Rep. Rob Hutton – “
Wisconsin health care has earned its place as a national leader in patient safety because of the hard work of hospitals like Children’s Wisconsin. This proactive quality improvement work, demonstrated and shared by Children’s to all hospitals in Wisconsin, benefits patients and their families by encouraging recovery strategies that lean less on pain medication, helping patients recover sooner and reducing opioid exposure among children.”