Opioid Stewardship

This project is being led by Dr. Steve Shew, Lucille Packard Children’s and Dr. Robert Ricca, Prisma Health Children’s.

Discharge opioid prescriptions are a known contributor to the opioid misuse and abuse in the general population including those prescribed to postoperative children. However, no broad scale accounting of opioid prescribing exists for pediatric patients who have undergone operations. Moreover, it is known from limited single and small multi-institutional studies that there is significant variation in opioid prescribing practices across sites and surgical specialties, most likely indicating potential to facilitate decreased opioid prescribing nationally.

Project Overview:

The Opioid Stewardship project builds on a study conducted by the Western Pediatric Surgery Research Consortium on post-op pain management in pediatric appendectomy patients. This study demonstrated an approach which significantly reduced the prescribing of narcotics for pain management at discharge without a significant increase in the number of readmissions or revisits for unmanaged pain complaints³. This project’s objective is to substantially reduce the prescribing of opioids at discharge, for our pediatric patients undergoing any surgical procedure included in the NSQIP-P platform. Ultimately qualitative interviews may be conducted near project conclusion to collect best practices from good performers and barriers from less good performers. These qualitative findings will be collated into an implementation guide and broadly distributed. Project duration is estimated to be 18-24 months.

Phase 1

a – Survey current basic opioid prescribing practices of different specialties from each site using current and newly created opioid specific NSQIP-Pediatric variables and establish regular self-reporting of sites to PSQC

b – Implement a site-specific opioid prescribing quarterly report generated from the PSQC to be used as blinded site comparison of their opioid stewardship efforts

c – Offer basic educational tools, known opioid sparing guidelines and potential QI coaching from select low opioid prescribing sites of different surgical specialties

 

Phase 2

a – Create a custom, multiple variable opioid dataset within NSQIP-pediatric to analyze across specific sites by procedure to generate risk adjusted effects toward highly effective opioid-sparing outcomes

b – Determine factors associated with most successful opioid sparing efforts and create most effective best practice opioid stewardship guidelines that could be disseminated to PSQC sites

c – Implement standardized best practice guidelines and track improvement efforts across PSQC sites over time toward effective minimizing opioid prescribing nationally

d – Facilitate creating standardized, site specific opioid stewardship SAR to be incorporated into NSQIP-Pediatric SARs

 

Workgroup Members:

Dr. Melissa Danko, Pediatric Surgeon, Vanderbilt Children’s, Nashville, TN

Ms. Betsy Diep, SCR, Kaiser Southern California, Los Angeles, CA

Ms. Ann Ellering, SCR, Minnesota Children’s, Minneapolis, MN

Dr. Brenna Fullerton, Pediatric Surgeon, Arnold Palmer Children’s, Orlando, FL

Ms. Carly Glander, CSVPM, Minnesota Children’s, Minneapolis, MN

Dr. Lorraine Kelley-Quon, Pediatric Surgeon, Children’s Hospital Los Angeles, Los Angeles, CA

Ms. Debra Liebrecht, SCR, Colorado Children’s, Denver, CO

Dr. Robert Ricca, Pediatric Surgeon, Prisma Health Children’s, Greenville, SC

Dr. Willemijn Schaefer, Implementation Scientist, Northwestern University, Chicago, IL

Ms. Tina Schwein, SCR, Seattle Children’s, Seattle, WA

Dr. Steve Shew, Pediatric Surgeon, Lucille Packard Children’s, Stanford, CA

Dr. Joshua Short, Pediatric Surgeon, Minnesota Children’s, Minneapolis, MN

Ms. Eleanor Wieseke, CSVPM, Peyton Manning Children’s, Indianapolis, IN

 

For additional information, please contact the PSQC Program Manager, Terry Fisher, at terry.fisher@uth.tmc.edu.

 

 

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