Leftover Opioid Analgesics and Disposal Following Ambulatory Pediatric Surgeries in the Context of a Restrictive Opioid-Prescribing Policy.
Leftover Opioid Analgesics and Disposal Following Ambulatory Pediatric Surgeries in the Context of a Restrictive Opioid-Prescribing Policy.
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DOI：
10.1213/ane.0000000000005503
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发表时间：
2022-01-01
影响因子：
5.7
通讯作者：
Franklin AD
中科院分区：
文献类型：
--
作者：
Stone AL;Qu'd D;Luckett T;Nelson SD;Quinn EE;Potts AL;Patrick SW;Bruehl S;Franklin AD
阿片类镇痛药通常用于儿科手术后的术后镇痛，通常会导致家中残留阿片类镇痛药。为了减少剩余阿片类药物的数量和整体社区阿片类药物负担，田纳西州颁布了一项政策，将最初的阿片类药物处方减少到3天供应，用于大多数急性疼痛事件。我们的目的是在国家强制限制阿片类药物处方政策的背景下，评估儿科门诊手术后剩余阿片类镇痛药的程度。我们还旨在评估阿片类药物的处置率，处置方法和不处置的原因。研究人员联系了300名儿科门诊手术后出院的阿片类药物处方儿科患者的父母。家长完成了关于阿片类药物使用和处置的回顾性电话调查。调查数据与病历数据相结合，以评估剩余阿片类药物处方剂量的比例。最终可分析样本n=185例患者（62%缓解率）处方了中位12次阿片类药物剂量（IQR：12 - 18），消耗了2次阿片类药物剂量（IQR：0 - 4），剩余10次阿片类药物剂量（IQR：7 - 13）。超过90%（n = 170/185）的父母报告他们有剩余的阿片类镇痛药，其中83%的处方剂量剩余。手术后，相当比例（29%，n = 54/185）的父母未使用处方阿片类药物。不到一半（42%，n = 71/170）的父母处理了剩余的阿片类药物，最常见的是冲下厕所，倒下水槽，或扔进垃圾桶。保留剩余阿片类药物的父母（53%，n = 90/170）最有可能将其保留在未锁定的位置（68%，n = 61/90）。父母描述了健忘和担心他们的孩子将来会经历疼痛是不处理剩余阿片类药物的主要原因。尽管田纳西州的政策旨在减少剩余的阿片类药物，但很大一部分处方阿片类药物是在儿科门诊手术后剩余的。大多数父母没有采取安全的阿片类药物处置措施。考虑到与家中剩余阿片类药物相关的安全风险，在儿科手术后需要进一步干预以提高处置率并定制阿片类药物处方。
Opioid analgesics are commonly prescribed for postoperative analgesia following pediatric surgery and often result in leftover opioid analgesics in the home. In order to reduce the volume of leftover opioids and overall community opioid burden, the State of Tennessee enacted a policy to reduce initial opioid prescribing to a 3-day supply for most acute pain incidents. We aimed to evaluate the extent of leftover opioid analgesics following pediatric ambulatory surgeries in the context of a state-mandated restrictive opioid prescribing policy. We also aimed to evaluate opioid disposal rates, methods of disposal, and reasons for non-disposal. Study personnel contacted the parents of 300 pediatric patients discharged with an opioid prescription following pediatric ambulatory surgery. Parents completed a retrospective telephone survey regarding opioid use and disposal. Data from the survey were combined with data from the medical record to evaluate proportion of opioid doses prescribed that were leftover. The final analyzable sample of n=185 patients (62% response rate) were prescribed a median of 12 opioid doses (IQR: 12 – 18), consumed 2 opioid doses (IQR: 0 – 4), and had 10 opioid doses leftover (IQR: 7 – 13). Over 90% (n = 170/185) of parents reported they had leftover opioid analgesics, with 83% of prescribed doses leftover. A significant proportion (29%, n = 54/185) of parents administered no prescribed opioids after surgery. Less than half (42%, n = 71/170) of parents disposed of the leftover opioid medication, most commonly by flushing down the toilet, pouring down the sink, or throwing in the garbage. Parents retaining leftover opioids (53%, n = 90/170) were most likely to keep them in an unlocked location (68%, n = 61/90). Parents described forgetfulness and worry that their child will experience pain in the future as primary reasons for not disposing of the leftover opioid medication. Despite Tennessee’s policy aimed at reducing leftover opioids, a significant proportion of prescribed opioids were leftover following pediatric ambulatory surgeries. A majority of parents did not engage in safe opioid disposal practices. Given safety risks related to leftover opioids in the home, further interventions to improve disposal rates and tailor opioid prescribing are warranted after pediatric surgery.
DOI：
10.3390/children7110236
发表时间：
2020-11-19
期刊：
Children (Basel, Switzerland)
影响因子：
--
作者：
Lee J;Delaney K;Napier M;Card E;Lipscomb B;Werkhaven J;Whigham AS;Franklin AD;Bruehl S;Stone AL
通讯作者：
Stone AL