Reducing the Use of Opioids for Pediatric Patients with Supracondylar Humerus Fractures

Winslow, L.; Holstine, Jessica; Samora, Julie Balch

doi:10.1016/j.jcjq.2020.06.010

Cited by 8 publications

(16 citation statements)

References 25 publications

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“…It has been attempted to establish protocols to mitigate the risk of inadequate opioid prescriptions for paediatric patients on nationwide, municipal, and institutional levels. 8 However, knowledge about current prescription patterns and modifiable risk factors for chronification of use is paramount to successfully implement such protocols. The purpose of this study was to (i) characterise opioid prescription patterns and (ii) describe the epidemiology and risk factors for the persistent use of opioids amongst paediatric patients who underwent surgical fracture treatment procedures using a nationwide database.…”

Section: Editor's Key Pointsmentioning

confidence: 99%

Persistent opioid use after surgical treatment of paediatric fracture

Zhong

Ladenhauf

Wilson

et al. 2021

British Journal of Anaesthesia

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Section: Editor's Key Pointsmentioning

confidence: 99%

Persistent opioid use after surgical treatment of paediatric fracture

Zhong

Ladenhauf

Wilson

et al. 2021

British Journal of Anaesthesia

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“…Other QI initiatives within pediatric orthopaedics, including in supracondylar humerus fractures and lower extremity trauma, have been similarly effective. 11,12 Data related to prescriptions, dosing, and refills was obtained for all patients through the electronic medical record. Information regarding pain control was gathered through patient and parent responses to surveys.…”

Section: Discussionmentioning

confidence: 99%

Simple Measures to Reduce Opioid Prescriptions Following Pediatric Spinal Fusion Surgery: A Multidisciplinary Quality Improvement Project

Winsauer¹,

Sharma²,

Bukowsky³

et al. 2021

Journal of the Pediatric Orthopaedic Society of North America

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Background:The opioid epidemic is one of the biggest challenges facing modern healthcare. Among the adolescent and young adult populations, opioid overdose is one of the leading causes of death.Local Problem: Within pediatric orthopaedics, spinal fusion is a common procedure making up 7% of the surgical volume at our institution. Spinal fusion also has high postoperative opioid prescribing rates. Review of baseline data showed that there was wide variability in prescribing habits. The goal of this quality initiative was to reduce and standardize postoperative opioid prescribing following spinal fusion procedures.Methods: Data, including opiate-prescribing habits and a patient survey to assess patient and parent satisfaction with pain control, was collected retrospectively in the pre-intervention phase for 99 consecutive adolescent and juvenile idiopathic scoliosis patients undergoing spinal fusion surgery. This was followed with two PDSA cycles following implementation of a new protocol during which prospective surveys were administered to a total of 273 patients. Physician prescribing data was collected for 150 patients during the sustain phase. Interventions:A multi-pronged approached was utilized consisting of the following aspects: 1) Instruction to orthopaedic trainees to limit opioid prescriptions to 45 and 40 for PDSA cycles 1 and 2, respectively, 2) A pharmacyled education program with an opioid tapering handout given to families and encouragement of usage of non-opioid pain control, and 3) A call to the prescribing physician from pharmacy if the prescribed dosage was greater than the maximum allowed.Results: There was a significant reduction in opioid prescriptions from a preintervention mean of 48.5 doses to a PDSA 1 mean of 39.0, PDSA 2 mean of 37.5, and a sustain phase mean of 36.4 (p=0.000). This represented an estimated reduction of 22.8% over the course of the study. During this time, there was no significant change in patient and parent reported postoperative pain.Conclusions: Through simple measures, our institution was able to significantly reduce total opioid prescriptions following spinal fusion surgeries while maintaining good pain control.

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“…19,20 We use a recent orthopaedic QI initiative focused on reducing opioid use in pediatric patients with supracondylar humerus fractures as a case example for conducting QI initiatives. 21 Figure 10 presents a hypothetical problem statement for this QI initiative. develop a clear understanding of the processes that influence it.…”

Section: Stanford Medicine Center For Improvement: Qi Video Seriesmentioning

confidence: 99%

A Step-by-Step Guide to Understanding and Conducting Quality Improvement Initiatives in Orthopaedic Surgery

Niekerk¹,

Shea²,

Samora³

et al. 2023

Journal of the Pediatric Orthopaedic Society of North America

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Numerous frameworks have been developed as methods to address complex quality improvement (QI) problems. We aim to provide orthopaedic surgeons with a foundational understanding of QI in order to facilitate their engagement in QI initiatives. We begin by providing a broad overview of QI terms and frameworks and then present a step-bystep guide for conducting QI initiatives using a popular, intuitive, and practical method: Lean (A3). We accompany our descriptions with links to publicly accessible short QI videos developed by the Stanford Medicine Center for Improvement. Additionally, we list key educational resources offered by the American Academy of Orthopaedic Surgeons (AAOS) and the Pediatric Orthopaedic Society of North America (POSNA) as well as provide information on a recently published textbook devoted to QI and patient safety in orthopaedic surgery.

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Reducing the Use of Opioids for Pediatric Patients with Supracondylar Humerus Fractures

Cited by 8 publications

References 25 publications

Persistent opioid use after surgical treatment of paediatric fracture

Persistent opioid use after surgical treatment of paediatric fracture

Simple Measures to Reduce Opioid Prescriptions Following Pediatric Spinal Fusion Surgery: A Multidisciplinary Quality Improvement Project

A Step-by-Step Guide to Understanding and Conducting Quality Improvement Initiatives in Orthopaedic Surgery

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