Multimodal Stepwise Approach to Reducing In-Hospital Opioid Use After Cesarean Delivery A Quality Improvement Initiative
Multimodal Stepwise Approach to Reducing In-Hospital Opioid Use After Cesarean Delivery A Quality Improvement Initiative
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DOI：
10.1097/aog.0000000000003156
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发表时间：
2019-04-01
影响因子：
7.2
通讯作者：
Poole, Aaron T.
中科院分区：
文献类型：
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作者：
Smith, Alisha M.;Young, Paul;Poole, Aaron T.
目的：评估剖宫产后住院疼痛管理的标准化、结构化方法与剖宫产后孕产妇阿片类药物使用的关系。方法：我们对在单一三级保健中心进行质量改善干预前后接受剖宫产的妇女进行了回顾性队列研究。一个多学科工作组修订了所有接受剖宫产经轴向麻醉的患者的电子医嘱集。修订后的命令将对乙酰氨基酚从阿片类药物中分离出来，计划对乙酰氨基酚和非甾体抗炎药的使用，并限制阿片类药物的使用以突破疼痛。数据通过电子图表审查收集。主要结果是每次住院期间吗啡毫克当量的中位数。次要结局包括每天吗啡毫克当量的中位数、疼痛评分的中位数、出院时间和阿片类-非阿片类止痛药的使用。进行了描述性和双变量分析。结果：干预前组（n=283）和干预后组（n=286）的基线特征无显著差异。每次住院的吗啡毫克当量中位数从干预前的120毫克（90-176四分位数范围）减少到干预后的30毫克（5-68毫克），减少了75%
OBJECTIVE: To evaluate the association of a standardized, structured approach to in-hospital postcesarean delivery pain management with maternal opioid use after cesarean delivery.METHODS: We conducted a retrospective cohort study of women who underwent cesarean delivery before and after a quality improvement intervention at a single tertiary care center. A multidisciplinary task force revised electronic order sets for all patients who underwent cesarean delivery with neuraxial anesthesia. The revised order set separated acetaminophen from opioids, scheduled acetaminophen and nonsteroidal antiinflammatory drug administration, and limited opioid use to breakthrough pain. Data were collected by electronic chart review. The primary outcome was median morphine milligram equivalents per hospital stay. Secondary outcomes included median morphine milligram equivalents per day, median pain scores, time to discharge, and opioid-nonopioid pain medication use. Descriptive and bivariable analyses were performed.RESULTS: There were no significant differences in baseline characteristics in the preintervention (n=283) and postintervention (n=286) groups. There was a 75% reduction in median morphine milligram equivalents per stay from 120 (90-176 interquartile range) preintervention to 30 (5-68) postintervention (P