In March, the American Academy of Pediatrics (AAP) Section on Surgery’s Executive Committee issued a six-month challenge to pediatric surgeons to decrease opioid prescribing by 50% at discharge.
Not long ago, writing a prescription for opioids was routine practice following surgery, says Vivian Thorne, Manager, Division of Hospital and Surgical Services at AAP. With rising overdoses and opioid addiction, this new initiative was created to address prescribing practices. In response, surgeons are being asked to prescribe opioid pain killers only when clinically necessary. Some practices, which have already instituted similar policies, have seen a dramatic decrease in the number of opioid prescriptions.
One of those practices is Nationwide Children’s Hospital in Columbus, OH. Kris Jatana, MD, FAAP, FACS, an otolaryngologist at the hospital, says his practice began a concerted effort to reduce opioid prescriptions approximately 18 months ago. Prior to that, every child three years and older who had surgery—the most common for his specialty is tonsillectomy—was routinely prescribed an opioid at discharge. Now, with the practice’s new protocol, that number has dropped by more than 50%.
It’s important to note, he said, that patients who are still medically in need of stronger pain meds do receive a prescription, but it is often fewer doses than before the policy was instituted. In the 18 months since establishing this new policy, opioid prescriptions have decreased by 75%. In addition, parents are given educational information about pain medications and asked to sign a consent form when opioids are required. “We certainly aren’t withholding medication if they need it,” Dr. Jatana stated.
One of the challenges, he said, is “there’s not a lot of data about what is needed for pain relief post-operatively.” What his practice learned from its patients and their families is that when opioids were prescribed, oftentimes the medication either was not used or far fewer pills were required than were prescribed. This results in leaving unused opioids in the medicine cabinet and available for others to use, which has been shown to be the source of how many individuals become addicted to prescription pain medications.
During the AAP effort, surgeons will be asked to measure their narcotic prescriptions using discharge prescriptions for 5 CPT codes. From that baseline, the Academy has challenged all surgeons to decrease by 50% the amount of opioids prescribed over the next six months.
PCSS has developed a core curriculum on prescribing opioids. Learn more
