![]() Therefore, in October 2019, we began the second plan-do-study-act cycle. Despite sharing monthly metrics, we observed that we were not meeting project goals, particularly with regard to opioid treatment duration and discharge instructions. Aggregate metrics were shared every quarter with all ED physicians via e-mail irrespective of their enrollment in the MOC project. We analyzed the EMR of all eligible patients for primary, secondary, and balance measures every 2 months. Physicians were educated on safe prescribing, storage, and disposal of opioids at commencement and every quarter through e-mail. The first plan-do-study-act cycle for the opioid stewardship project began in May 2018. The interventions consisted of physician education and feedback, enrollment in the PMP, rollout of revised discharge instructions, and changes in EMR functionality. Our goals, which were prespecified before project initiation, were to achieve the following quality measures within 24 months of project commencement: primary process measure and balance measure. Baseline data revealed that of the 1965 patients with fractures (1645) or abscesses (320), opioids were prescribed in 266 (13.5%) encounters and for >3 days in 110 (41.4%) of those encounters, codeine constituted 1.1% of prescribed opioids (3 of 266), no ED physician was enrolled in the PMP, and no discharge instructions on safe storage and disposal of prescription opioids were available. We excluded complex, open, and femur fractures because they require hospital admission and/or operative care and excluded conditions for which opioids are rarely prescribed, such as fractures involving the clavicle, upper humerus, and foot Supplemental Table 3). Opioids included morphine, hydrocodone, oxycodone, and codeine as a single ingredient or in combination with acetaminophen. 15 Therefore, it is important to limit exposure of adolescents to prescription opioids.īaseline data for 2017 extracted from the electronic medical records (EMRs) consisted of age, sex, diagnosis, procedure performed, opioid discharge prescription (written or e-prescribed), prescription duration (days), and total volume (milliliters) and/or number of doses prescribed. 14 Opioid use in adolescence is associated with nonmedical use of prescription opioids in young adulthood. Mandatory querying of the PMP for a patient’s previous use of opioids is associated with significant lowering of prescription drug misuse in young adults. 12 In addition, prescriber use of the prescription drug monitoring program (PMP) is low 13 and its use in pediatric emergency medicine is unknown. 9– 11 In a pediatric acute-care setting, the odds of receiving an opioid prescription for >5 days were higher among infants and among patients whose prescriptions were written by a resident physician. 7, 8 This can lead to marked variability in opioid prescribing. Clinicians may prescribe greater amounts of opioids than is necessary for the treatment of acute pain in children 7 because of a lack of evidence-based guidelines regarding the appropriate type and quantity of opioids to be prescribed for medical conditions. Physician prescribing habits also contribute to the availability of prescription opioids.
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