A Quality Improvement Project to Reduce Combination Acetaminophen-opioid Prescriptions to Pediatric Orthopedic Patients

Facile Synthesis of Hollow Fe3O4-rGO Nanocomposites for the Electrochemical Detection of Acetaminophen

Acetaminophen (AC) is one of the most popular pharmacologically active substances used as an analgesic and antipyretic drug. Herein, a new type of hollow Fe₃O₄-rGO/GCE electrode was prepared for electrochemical detection of AC through a three-step approach involving a solvothermal method for the synthesis of hollow Fe₃O₄ and the chemical reduction of graphene oxide (GO) for reduced graphene oxide (rGO) and Fe₃O₄-rGO nanocomposites modified on the glassy carbon electrode (GCE) surface. The as-prepared Fe₃O₄-rGO nanocomposites were characterized using a transmission electron microscope (TEM), X-ray diffraction (XRD), and a magnetic measurement system (SQUID-VSM). The magnetic Fe₃O₄-rGO/GCE electrodes were employed for the electrochemical detection of AC using cyclic voltammetry (CV), electrochemical impedance spectroscopy (EIS), and square wave voltammetry (SWV) and exhibited an ultra-high selectivity and accuracy, a low detection limit of 0.11 µmol/L with a wider linear range from 5 × 10^-7 to 10^-4 mol/L, and high recovery between 100.52% and 101.43%. The obtained Fe₃O₄-rGO-modified GCE displays great practical significance for the detection of AC in drug analysis.

Reducing Opioid Prescriptions after Common Outpatient Pediatric Urologic Surgeries: A Quality Improvement Assessment

Pediatric patients undergoing outpatient surgeries often receive prescriptions for postoperative pain, including opioid medications. As a result, the American Academy of Pediatrics formally challenged all pediatric surgeons to decrease opioid prescribing for common specialty-specific outpatient procedures at discharge. To meet this challenge, we designed a quality improvement project to decrease the average number of opioid doses administered to pediatric patients undergoing 3 common outpatient urologic surgeries: circumcision, orchiopexy, and inguinal hernia repair (IHR).

Methods

We formally challenged providers at our institution to reduce opioid doses per prescription and administration to patients overall. We performed a retrospective chart review at our single pediatric institution to establish baseline opioid prescribing values from July 2017 to March 2018. We aimed to reduce this value by 50% in 6 months and sustain this decrease throughout the project duration.

Results

We performed 1,518 orchiopexies, 1,505 circumcisions, and 531 IHRs. The percent change in the average number of opioid doses prescribed per patient from baseline values assessed to 2021 was statistically significant for orchiopexies (P < 0.0001), IHRs (P < 0.0001), and circumcisions (P < 0.0001). In addition, the change in the percentage of patients prescribed opioids from baseline was statistically significant for all 3 procedures (P < 0.001).

Conclusions

This project demonstrated that through an organized quality improvement initiative, the average number of opioid medications prescribed and the total percentage of patients prescribed opioids following common outpatient pediatric urologic procedures can be decreased by at least 50% and sustained through project duration.

Standardizing Opioid Prescribing in a Pediatric Hospital: A Quality Improvement Effort

BACKGROUND

Opioids are indicated for moderate-to-severe pain caused by trauma, ischemia, surgery, cancer and sickle cell disease, and vaso-occlusive episodes (SCD-VOC). There is only limited evidence regarding the appropriate number of doses to prescribe for specific indications. Therefore, we developed and implemented an opioid prescribing algorithm with dosing guidelines for specific procedures and conditions. We aimed to reach and sustain 90% compliance within 1 year of implementation.

METHODS

We conducted this quality improvement effort at a pediatric academic quaternary care institution. In 2018, a multidisciplinary team identified the need for a standard approach to opioid prescribing. The algorithm guides prescribers to evaluate the medical history, physical examination, red flags, pain type, and to initiate opioid-sparing interventions before prescribing opioids. Opioid prescriptions written between January 2015 and September 2020 were included. Examples from 2 hospital departments will be highlighted. Control charts for compliance with guidelines and variability in the doses prescribed are presented for selected procedures and conditions.

RESULTS

Over 5 years, 83 037 opioid prescriptions in 53 804 unique patients were entered electronically. The encounters with ≥1 opioid prescription decreased from 48% to 25% between 2015 and 2019. Compliance with the specific guidelines increased to ∼85% for periacetabular osteotomies and SCD-VOC and close to 100% for anterior-cruciate ligament surgery. In all 3 procedures and conditions, variability in the number of doses prescribed decreased significantly.

CONCLUSION

We developed an algorithm, guidelines, and a process for improvement. The number of opioid prescriptions and variability in opioid prescribing decreased. Future evaluation of specific initiatives within departments is needed.