Reduction of opioid utilization after vaginal delivery with an electronic health record intervention.

Abstract

BACKGROUND\nThe national epidemic of opioid misuse has focused attention on postpartum analgesic utilization. Adequate pain control achieved with non-opioid pain medications and conservative measures could minimize the quantity of opioid pain medications available for misuse and diversion. Interventions that decrease inpatient opioid use after delivery could reduce the potential for chronic dependence in postpartum women. Modification of preloaded electronic order sets to decrease opioid administration has successfully reduced opioid use following major abdominal surgery including cesarean delivery. However, interventions to reduce opioid use following vaginal delivery are not well-described.\n\n\nOBJECTIVE\nWe aimed to evaluate the effect of removing opioid medications from postpartum order sets on medication utilization following vaginal delivery.\n\n\nSTUDY DESIGN\nWe performed a retrospective cohort study of women undergoing a singleton vaginal delivery at an academic tertiary care center. Our institution removed opioid medications from postpartum order sets in April 2018. We compared two delivery cohorts: Pre-Intervention (April 2016 - March 2018), and Post-Intervention (June - July, 2018). Primary outcome was postpartum opioid use. Secondary outcomes were non-opioid analgesic use and discharge with an opioid prescription. We compared demographic and obstetric data, self-reported pain scores, and postpartum analgesic utilization between groups. We determined that a minimum of 138 patients would be needed in each group to identify a 20% decrease in opioid usage (α\u202f=\u202f.05, β\u202f=\u202f.2).\n\n\nRESULTS\nWe analyzed 276 subjects; 138 pre- and 138 post-intervention. The post-intervention group was older and more likely to have an operative vaginal delivery. Otherwise, groups had similar demographic and obstetric characteristics. Postpartum opioid use decreased from 56% pre-intervention to 16% post-intervention, a 71% reduction (p < .001). Incidence of severe pain score (> 7) was similar between groups with median occurrence of 1, IQR (0,4) for both (p\u202f=\u202f.7). Number of opioid discharge prescriptions among those receiving inpatient opioids was significantly lower in the post intervention group at 18% versus 38% in the pre-intervention group, a 53% decrease (p < .001).\n\n\nCONCLUSION\nRemoval of opioids from the postpartum order set was associated with lower rates of opiate usage following vaginal delivery in a single center without changing the frequency of severe pain scores. This simple intervention has the potential to reduce opioid exposure.