A multimodal approach to reducing post-caesarean opioid use: a quality improvement initiative.

Objective: To evaluate the impact of a QI initiative to reduce post-caesarean opioid use.

Design: Retrospective cohort study.

Setting: Academic hospital in the USA.

Population: Women over 18 years undergoing caesarean section.

Methods: A quality improvement (QI) initiative titled Reduced Option for Opioid Therapy (ROOT) was implemented in women undergoing caesarean section. The intervention included implementation of a postpartum order set maximising the use of scheduled NSAIDs and acetaminophen. Additionally, nursing education promoted non-opioid therapy as first-line, with opioids reserved for breakthrough pain. Performance feedback was provided to nursing staff on a bimonthly basis. Post-caesarean opioid use was reviewed in the 6 months before and after implementation of ROOT.

Main Outcome Measures: The primary outcome was the total morphine milligram equivalents (MME) consumed during the postpartum admission. Secondary outcomes included opioid use per postoperative day, the proportion of opioid-free admissions, the percentage of patients discharged with a prescription for opioids, prescription size, and pain scores.

Results: Following implementation of ROOT, median inpatient opioid use decreased by more than 60%, from 75 to 30 MME per admission (P < 0.001). The proportion of opioid-free admissions increased from 12.6% pre-intervention to 30.7% post-intervention (P < 0.001). Additionally, the median opioid dose prescribed at discharge decreased in the post-intervention cohort, and the proportion of patients discharged without an opioid prescription increased. The reduction in opioids was associated with a slight decrease in patient-reported pain scores.

Conclusions: Implementation of ROOT significantly reduced opioid use while achieving comparable pain control.

Tweetable Abstract: Nursing education, and use of an order set prioritising non-opioid analgesics reduces post-caesarean opioid use.