P045: BETWEEN ROCK AND HARD PLACE: OPIOID PRESCRIPTIONS IN PEDIATRICS
Joseph E LaGrew, MD1, Taran Sangari, MD1, Romano DeMarco, MD2, Timothy Martin, MD1; 1University of Florida Department of Anesthesiology, 2University of Florida Department of Urology
Introduction: The objective of this quality improvement project was to review the use of narcotic prescriptions in outpatient pediatric surgical patients. Patient caregivers were surveyed to determine if patients had adequate post-operative pain control, had any unused narcotics after the completion of treatment and their knowledge with competency about the disposal methods of excess narcotic medication.
Methods: The caregivers for 30 patients who underwent circumcision surgery from September to November of 2018 were queried by phone regarding patient’s post-operative pain control and narcotic usage at home. Questions addressed pain control, if prescription was filled, how many opioid doses were given, disposal of unused narcotic dosages, and if caregivers were educated in regards to the proper disposal of unused narcotics. All data was analyzed with descriptive statistics. For all caregivers called, the purpose of the call and verbal permission to proceed was solicited prior to inclusion. This project was approved by departmental and hospital quality committees.
Results: Among 30 caregivers who were contacted via phone call, 15 responded. Age range of these patients was 6 months to 2 years (average 13 months) and the body weight was 7.1kg to 15.4kg (average 10.2kg). Of those 15 caregivers who responded, all 15 (100%) reported adequate observed pain control at home, and 12 (80%) reported filling narcotic prescription. Of the 12 patients who filled the prescription, 9 patients (75%) reported requiring oxycodone for post-operative pain control. Out of 216 to total doses (18 doses prescribed to each of 15 patients), only 30 doses (14%) were administered. The median dose consumed by all patients who filled the prescription was 1 dose. 9 caregivers (75%) who filled the narcotic prescription kept the unused narcotic at home after pain subsided.
Discussion: Based on our data from one surgeons’ patients for circumcision, we found there were 186 (86%) unused narcotic doses. Having each dose be individualized per patient, represents significant burden of time; however, writing a 3 day prescription for all patients is excessive as shown in the cohort here. We propose algorithm based education, planning and prescription writing that is surgery specific. Focused education to assess caregiver understanding including when to fill prescription and how to dispose narcotics should be reinforced with cognitive aids.
Conclusion: This quality review in a small cohort of caregivers experience with opioid prescription demonstrates the potential for tailored prescribing practices. We recommend focus should be on education and planning for post-operative pain control for commonly performed procedures that accounts for differences in patient opioid requirements.