A Quality Improvement Project to Effectively Decrease Opioid Prescribing for Adolescents after Posterior Spinal Fusion Surgery

Introduction: Pain is the greatest concern discussed preoperatively for patients undergoing a posterior spinal fusion (PSF) for Adolescent Idiopathic Scoliosis. Opioid stewardship for postoperative pain management is a priority for families and their clinical care team. The use of evidence-based interventions to reduce the reliance on opioids is key to any comprehensive institutional opioid policy. Methods: This Quality Improvement (QI) project included creating an opioid bundle consisting of parent/adolescent education, a suggested medication weaning schedule at discharge, updated prescribing guideline decreasing the number of opioids prescribed from 40 doses to 28 doses, and a consent for opioids to be prescribed. The spine team utilized IHI Plan, Do, Study, Act methodology to implement the opioid bundle over twelve-weeks. De-identified data was collected pre- and post- implementation regarding opioid use. Results: The opioid bundle was deployed 100% of the time for the patients that met inclusion criteria during this QI initiative. Prior to the QI initiative, the median number of opioid doses prescribed was 40, and after the opioid bundle was used, the median was 28 doses. After the QI initiative, the spine center did not find an increase in parent phone calls and no refills for opioids were given. Discussion: Addressing family concerns for effective post-discharge care for their adolescent at home needs to include education about the risks, side effects, benefits, and use of medications prescribed, including how to assess when medications are needed and how to monitor usage. This QI initiative provided hands-on tools to help with pain management in the home while successfully decreasing the number of opioids prescribed.No embarg