Randomized clinical trials have demonstrated that scheduled high-dose acetaminophen (SHDA) decreases post-operative pain and opioid consumption; however, this is not yet common knowledge or practice. Our objective was to design an intervention for physical medicine and rehabilitation residents and fellows that increases their likelihood of prescribing SHDA for patients in acute rehabilitation with post-operative pain.
16 resident/fellow participants received a case vignette of a patient being admitted to acute rehabilitation on opioids status-post lumbar laminectomy. Participants completed a medication reconciliation task then a pre-test on acetaminophen prescribing practices. Next, participants received an original one-page pamphlet detailing the utility of SHDA, and a post-test. Two weeks later, the same case vignette, medication reconciliation task, and post-test were given. Additionally, a retrospective chart review was performed on all post-operative patients admitted to our inpatient rehabilitation facility before and after the intervention among a subset of 4 resident participants on inpatient units. Study outcomes included self-perceived likelihood to prescribe SHDA, performance on the medication reconciliation task, and rate of actual SHDA prescription on the inpatient rehabilitation units.
Among 16 participants, self-rated likelihood to prescribe SHDA significantly increased following the intervention, both at day one (p< 0.001) and two weeks follow-up (p=0.001). Participants were significantly more likely (p=0.004) to prescribe SHDA on the medication reconciliation task (0/16 before versus 8/16 after the intervention). Among actual patients in acute rehabilitation with post-operative pain, following the intervention there was a 9.1% increase in the rate of SHDA prescription among the 4 inpatient residents (0/58 before versus 5/55 patients after the intervention).
This project established an effective and low-cost intervention to promote evidence-based medicine and decrease pain and opioid consumption in post-operative patients. With further development, our intervention can be given across multiple acute rehabilitation settings to residents, fellows, and attending physicians.
Steven Markos– Resident Physician, Academic Chief, JFK Johnson Reabilitation Institute
Aakash Thakral– Chief Resident, Rutgers RWJ JFK Johnson Rehabilitation Institute
Lei Lin– Attending Physician / Associate Professor, Rutgers /RWJMS JFK Johnson Rehab Institute
Sara Cuccurullo– Chair, Professor, Residency Director, 1996