A Project to Reduce Opioid Administration for Women in the Postpartum Period

Abstract

Objective: To decrease the need for opioids for women in the postpartum period by using the PainPack Protocol to administer alternating acetaminophen and ibuprofen.

Design: Quality improvement project.

Setting: Southwestern Ohio Level II community hospital with approximately 4,000 births per year.

Participants: A pilot group of women who gave birth from July 2017 through December 2017 (n = 210). Full implementation included women who gave birth from January 2018 through June 2019 (n = 5,560).

Intervention/measurements: The PainPack Protocol used in the outpatient setting was modified and implemented for use in the inpatient setting. Outcomes were measured via chart review and were based on morphine milligram equivalents (MMEs) given in the hospital and prescribed after discharge. Feedback from women during nurse leader rounds was also considered.

Results: The average amount of MMEs administered in the hospital was reduced from 143.2 to 105.8 for women birthing via cesarean and from 32.8 to 26.1 for women birthing vaginally. The average amount of MMEs prescribed at discharge was reduced from 281.0 to 166.9 for women birthing via cesarean and from 99.0 to 45.0 for women birthing vaginally.

Conclusion: This protocol was associated with reduced amounts of opioids administered to women during postpartum hospitalization and prescribed upon discharge. At the same time, women reported effective pain control during nurse leader rounds.

Keywords: PainPack Protocol; acetaminophen; ibuprofen; inpatient; maternity; opioid; pain.