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Introduction: Deaths related to drug overdose are at record highs, with over 110,000 recorded from May 2022-2023.1 75% of drug overdose deaths can be attributed to opioids.1 Pediatric opioid exposure is significant, with 406,000 American teens reporting illicit opioid use in 2022.2 Increased prescription opioids in circulation leads to increased opportunity for ingestion by children and adolescents. Current literature suggests most pediatric patients may only use one-two days’ worth of opioid doses prescribed for acute pain control, with the rest of prescribed doses going unused.3 From 2022-2023 in the Children’s Mercy Emergency Department (ED), 48% of children prescribed opioids for fractures had prescriptions exceeding eight doses. We aim to reduce the percentage of opioid prescriptions for fractures that exceed eight doses in pediatric patients (age: 0 to 18 years) discharged from the ED from 48% to 38%, with a stretch goal of 28% by June 2024. Methods: A3 improvement methodology was utilized. Root causes were identified, and a key driver diagram was created (Fig 1). Interventions to date have included electronic medical record (EMR) optimization by updating default opioid prescribing order sentences for acute fractures and provider education. The outcome measure was the monthly percentage of opioid prescriptions for acute factures with greater than 8 doses prescribed. Statistical process p-chart assessed the impact of interventions over time. Results: To date, 2,973 patients have been included (2,357 baseline period [1/2021-11/2023]; 616 implementation period [12/2023-9/2024]). Special cause variation was displayed after our second intervention with both 8 consecutive points below the baseline centerline and one data point falling outside 3-sigma (2/2024). Performance improved from a baseline of 48% to 21% and has remained sustained for 7 additional months without need of further interventions (Fig. 2). Conclusions: Through optimization of default opioid prescribing order sentences in the EMR and provider education, we achieved a sustained reduction in excess opioids prescribed for patients discharging home from the ED with a diagnosis of fracture. This project is translatable across diagnostic codes and various EMR systems and is one of the many interventions needed towards curbing unintentional and intentional opioid ingestions within our pediatric community.

Publication Date

4-2025

Disciplines

Emergency Medicine | Pediatrics

When and Where Presented

Presented at the 2025 Pediatric Academic Societies (PAS) Annual Meeting; Honolulu, HI; April 24-28, 2025.

More of Less: Optimizing Opioid Prescriptions for Acute Fractures in the Emergency Department at a Children’s Hospital

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