{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:01:31Z","timestamp":1788314491762,"version":"build-2803163510"},"reference-count":32,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,2,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND<\/jats:title>\n                  <jats:p>Opioids are indicated for moderate-to-severe pain caused by trauma, ischemia, surgery, cancer and sickle cell disease, and vaso-occlusive episodes (SCD-VOC). There is only limited evidence regarding the appropriate number of doses to prescribe for specific indications. Therefore, we developed and implemented an opioid prescribing algorithm with dosing guidelines for specific procedures and conditions. We aimed to reach and sustain 90% compliance within 1 year of implementation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>We conducted this quality improvement effort at a pediatric academic quaternary care institution. In 2018, a multidisciplinary team identified the need for a standard approach to opioid prescribing. The algorithm guides prescribers to evaluate the medical history, physical examination, red flags, pain type, and to initiate opioid-sparing interventions before prescribing opioids. Opioid prescriptions written between January 2015 and September 2020 were included. Examples from 2 hospital departments will be highlighted. Control charts for compliance with guidelines and variability in the doses prescribed are presented for selected procedures and conditions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Over 5 years, 83\u2009037 opioid prescriptions in 53\u2009804 unique patients were entered electronically. The encounters with \u22651 opioid prescription decreased from 48% to 25% between 2015 and 2019. Compliance with the specific guidelines increased to \u223c85% for periacetabular osteotomies and SCD-VOC and close to 100% for anterior-cruciate ligament surgery. In all 3 procedures and conditions, variability in the number of doses prescribed decreased significantly.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSION<\/jats:title>\n                  <jats:p>We developed an algorithm, guidelines, and a process for improvement. The number of opioid prescriptions and variability in opioid prescribing decreased. Future evaluation of specific initiatives within departments is needed.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/hpeds.2021-005990","type":"journal-article","created":{"date-parts":[[2022,1,21]],"date-time":"2022-01-21T08:12:38Z","timestamp":1642752758000},"page":"164-173","source":"Crossref","is-referenced-by-count":6,"title":["Standardizing Opioid Prescribing in a Pediatric Hospital: A Quality Improvement Effort"],"prefix":"10.1542","volume":"12","author":[{"given":"Carolina","family":"Donado","sequence":"first","affiliation":[{"name":"Departments of Anesthesiology, Critical Care and Pain Medicine and"},{"name":"Departments of Anestheasia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean C.","family":"Solodiuk","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology, Critical Care and Pain Medicine and"},{"name":"Departments of Anestheasia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan T.","family":"Mahan","sequence":"additional","affiliation":[{"name":"Orthopedics"},{"name":"Departments of Orthopaedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel L.","family":"Difazio","sequence":"additional","affiliation":[{"name":"Orthopedics"},{"name":"Departments of Orthopaedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew M.","family":"Heeney","sequence":"additional","affiliation":[{"name":"Dana-Farber\/Boston Children\u2019s Cancer and Blood Disorders Center, Boston, Massachusetts"},{"name":"Pediatrics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy J.","family":"Starmer","sequence":"additional","affiliation":[{"name":"Pediatrics, Harvard Medical School, Boston, Massachusetts"},{"name":"Division of General Pediatrics, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph P","family":"Cravero","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology, Critical Care and Pain Medicine and"},{"name":"Departments of Anestheasia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles B.","family":"Berde","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology, Critical Care and Pain Medicine and"},{"name":"Departments of Anestheasia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine D.","family":"Greco","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology, Critical Care and Pain Medicine and"},{"name":"Departments of Anestheasia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2022,1,21]]},"reference":[{"issue":"13","key":"2022020117490109500_b1","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1056\/NEJMra1507771","article-title":"Opioid abuse in chronic pain\u2014misconceptions and mitigation strategies","volume":"374","author":"Volkow","year":"2016","journal-title":"N Engl J Med"},{"issue":"13","key":"2022020117490109500_b2","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1001\/jama.2011.370","article-title":"Association between opioid prescribing patterns and opioid overdose-related deaths","volume":"305","author":"Bohnert","year":"2011","journal-title":"JAMA"},{"issue":"15","key":"2022020117490109500_b3","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1001\/jama.2016.1464","article-title":"CDC guideline for prescribing opioids for chronic pain\u2014United States, 2016","volume":"315","author":"Dowell","year":"2016","journal-title":"JAMA"},{"key":"2022020117490109500_b4","unstructured":"The 192nd General Court of the Commonwealth of Massachusetts. 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