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Sometimes Less is More: Decreasing the Amount of Opioids Prescribed After Cesarean Section


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Sometimes Less is More: An Effort to Decrease Amount of Opioids Given Post-Cesarean Section

Martha Tesfalul MD1, Biftu Mengesha MD MAS1,2

1Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco | 2Zuckerberg San Francisco General Hospital (ZSFG)


•Judicious prescription of opioid medications is vital to curbing the opioid epidemic and its devastating consequences (Figure 1)
•After cesarean sections, often more opioids are prescribed than consumed
•Studies suggest that 150 morphine milligram equivalents (MME) or less  is sufficient for majority of women  [Bateman et al, 2017]
•At ZSFG from March to August 2017 approximately 1 in 4 women who had a cesarean section received more than 150 MME on discharge, highlighting an opportunity to decrease overprescription


•Educate providers on normative opioid use upon discharge after cesarean section
•Decrease amount of opioid medication prescribed upon discharge after cesarean section


•Who? Women undergoing cesarean section
•What? Decrease % of women receiving > 150 MME on discharge compared to baseline rates from March - August 2017
•Where? ZSFG Birth Center
•When? November 2017 – June 2018
•Why? Normative data from recent studies on discharge opioid use

Results (prelim)

•Notable decline  in proportion of women prescribed >150 MME on discharge after cesarean section
–Baseline: 26 of 113 (23%)
–Since Project Start: 5 of 102 (5%)
•Doubling of  proportion  of women not prescribed opioids on discharge after cesarean section
–Baseline: 26 of 113 (23%)
–Since Project Start: 46 of 102 (45%)


•Achieved significant reduction in the percentage of women receiving >150 MME (23% pre-intervention, 5% post-intervention, p = <0.001)
•Indicative of the large role data on normative pain medication patterns and provider education can play in decreasing the amount of opioids prescribed

Next Steps

•Continue data collection and analysis until June 2018
•Collect  post-discharge data from women who deliver at ZSFG regarding their opioid use, pain scores , potential adverse side effects, and opioid disposal
•Develop patient education tool on safe medication storage and disposal

To truly stop this crisis, we have to avoid creating dependence in the first place. And that means revisiting and rethinking the revolution in pain management that has taken place over the past several decades, which has done a great deal of good but also had devastating unintended consequences for millions of patients.

 - Dr. Thomas Price, Former  HHS Secretary

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