A Quality Improvement Initiative Addressing Safe Opioid Prescribing and Disposal Postcesarean Delivery.

Background: Misuse of prescription opioids is a public health crisis in the United States. In 2016, it was estimated that 3.3 million Americans were misusing prescription opioids (SAMHSA, 2017) and nearly 63,632 deaths were due to prescription opioid misuse. From 1999 to 2010, the number of prescription opioid drugs sold to health care facilities from pharmaceutical companies, nearly quadrupled. Cesarean delivery is the most common surgical procedure performed in the United States and opioids are most often chosen to manage post-operative pain. Research has shown that women, who deliver via cesarean section, are prescribed an excess of opioid tablets upon discharge and often store them in unsecure locations. Furthermore, the vast majority, are not disposed of properly.

Aims: The purpose of this quality improvement project was to assess whether a shared decision-making tool between a discharging obstetric provider and post-cesarean section patient can reduce the pool of unused opioids in the community.

Design: A one-group pre/post survey design was used to conduct this study.

Setting: 537-bed teaching hospital composed of 12 labor, delivery and recovery suites, 3 operating suites, and 33 postpartum suites.

Participants: Engish speaking women, 18 years or older who delivered by cesarean section.

Methods: A shared decision-making session was implemented on a computer-based tablet, led by the discharge provider and woman following cesarean section on day of discharge. The tool focused on pain expectations, multi-modal methods (both pharmacologic and non-pharmacologic) to manage pain, safe storage, and disposal of excess medication. Women chose the number of 5-mg oxycodone tablets they would be prescribed, up to the institutional standard of 30. Women were provided a home opioid deactivation system to dispose of any excess tablets. A follow-up phone call was completed two weeks following discharge.

Results: Sixty women participated in the initiative. The mean number of 5-mg oxycodone tablets prescribed was 18. Women consumed a mean of 13 tablets, with 6 remaining. Eighty-eight percent (n = 33) of women disposed of their excess tablets, with 52% utilizing the opioid deactivation system provided. The initiative resulted in 92% (n = 47) of patients utilizing all of their prescribed tablets or properly disposing of them.

Conclusion: Engaging post-operative patients in decisions regarding pain management, educating women on multi-modal methods to manage pain, and providing women with a means to properly dispose of excess tablets, can reduce opioid tablets available for misuse and diversion in the community.