Category: Professional Posters
Purpose: Opioid dependence and abuse is a well-known national crisis. CDC Guidelines for prescribing indicate opioid use should be aimed at improving function and quality of life. The purpose of this performance improvement project was to validate results from another site of care to determine if a multimodal pain medication regimen with a Therapeutic Activity Goal dosing strategy for opioids could be implemented to reduce opioid use and keep patient’s pain controlled. A Therapeutic Activity Goal is a functional goal, specific to the patient, developed by the care team and patient to advance healing and rehabilitation necessary for discharge.
Methods: The multi-disciplinary orthopedic team collaborated to implement a novel pain strategy in a 311 bed community hospital. The intervention included the use of a multimodal pain order set with acetaminophen 975mg every 6 hours and celecoxib 200mg daily, and an as needed opioid. Therapeutic Activity Goals were assigned to each patient and used to determine opioid dosing and administration. If the patient was unable to accomplish this activity without a predetermined, acceptable level of pain, the patient would be administered an opioid from the multimodal order set. Orthopedic patients receiving total hip and total knee arthroplasties, aged greater than 18 were included and excluded were those that were admitted longer than 7 days. Primary outcomes were opioid administration across the length of stay and average pain score during hospitalization. Data was collected from August to December 2017 and compared to baseline data from January to December 2016.
Results: The opioid administration in oxycodone equivalents decreased from an average over the inpatient stay of 164mg at baseline to 39 mg, which represented a 76% decrease in opioid usage (p<0.05.) Pain scores showed a reduction of 4.5 at baseline to 4 during the pain pilot (p<0.05.)
Conclusion: Use of the multimodal order set with associated Therapeutic Activity Goals for as needed pain medication reduced the amounts of opioid the post-surgical patients received, and improved pain scores. The success of this pilot along with another pilot site has facilitated the expansion of the multimodal order set and Therapeutic Activity Goal across a large healthcare organization.