Implementation of a Pediatric Posttonsillectomy Pain Protocol in a Large Group Practice

Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
Lauren J LukAnna H Grosz

Abstract

In response to the increased risk of respiratory failure and death after tonsillectomy related to codeine use, Kaiser Permanente Northwest restricted use of opioids in patients <7 years old via electronic health record (EHR). However, opioids could be prescribed at physician discretion by overriding the EHR. This study aims to examine protocol compliance in a large group practice using EHR order sets and complication rates as compared with historical data. Case series with chart review. Ambulatory care within a health maintenance organization. Procedural codes were used to identify children <7 years old who underwent tonsillectomy or adenotonsillectomy approximately 1.5 years before and after implementation of EHR protocol (n = 437). Primary outcome was opioid pain prescriptions received by patients. Secondary outcomes were emergency or urgent care utilization, postoperative bleeding, nausea, vomiting, dehydration, death, and reasons for prescribing opioid pain medication after EHR protocol implementation. Chi-square analysis and Fischer's exact testing were used to compare differences in event rates. Implementation of an age-based narcotic protocol significantly decreased physician narcotic prescribing from 82.2% to 15.4% (P <...Continue Reading

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References

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Citations

Oct 13, 2016·International Journal of Pediatric Otorhinolaryngology·Maria Claudia RodríguezTatiana Castillo
Oct 31, 2017·Current Opinion in Otolaryngology & Head and Neck Surgery·Sophia D Becker, Daniel G Becker
Dec 27, 2018·The Laryngoscope·Rachel L WhelanDavid H Chi
Mar 25, 2020·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Calista M HarbaughSamir K Gadepalli
Jun 4, 2020·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Rebecca AwadallaJonathan Penm
Aug 5, 2020·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Daniel C O'BrienBrian Kellermeyer
Mar 5, 2019·Laryngoscope Investigative Otolaryngology·Kathleen R BillingsKatherine Barsness
Aug 25, 2018·JAMA Surgery·Martha WetzelMehul V Raval
Oct 7, 2020·The Laryngoscope·Yusuf M AgamawiJennifer V Brinkmeier
Jan 25, 2021·Journal of the American College of Surgeons·John A HarvinUNKNOWN MAST Study Group
Apr 7, 2021·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Samantha AnneTaskin M Monjur
Aug 20, 2021·Health Services Research·Martha WetzelJason M Hockenberry

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