For children, the opioid epidemic can be about adults in their lives with opioid use disorder or accidental overdoses when a child finds their parent's pill bottle. But kids can also get addicted to opioids.
Mayo Clinic's Courtney Baker, M.D., an orthopedic surgical resident, and his mentor, Todd Milbrandt, M.D., a pediatric orthopedic surgeon, decided to lessen the chances of these happenings. Together with other colleagues from Orthopedic Surgery and the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, they led the implementation and evaluation of tiered prescribing guidelines for discharge opioid prescriptions following common pediatric orthopedic procedures.
In a recent article in the Journal of Pediatric Orthopedics, the team describes their findings.
"The first shocking thing we found was a 60% reduction in opioids prescribed based on this simple intervention," says Dr. Baker, the study's first author. "This means a drastic reduction in the amount of extra opioids available in the home."
"Second, adherence to the guidelines was over 90% by providers," he continues, "which means that these guidelines were easily adopted and maintained with minimum education or training required."
The team worked with Mayo's pediatric orthopedic surgeons to develop a tiered list of 28 procedures — according to the invasiveness of the procedure and a typical postprocedural opioid requirement. They then developed a tiered dosing table for oxycodone, and another for hydrocodone/acetaminophen, based on the weight of the patient and the level of the procedure. These guidelines were distributed across Mayo's Practice in January 2018 and implemented during that year.
All patients, ages 0-17 who underwent one of the 28 procedures in 2017 — prior to guideline development — were compared to all similar patients from 2019.
Read the rest of the article on Advancing the Science.
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