A multimodal approach to reducing post‐caesarean opioid use: a quality improvement initiative

Objective To evaluate the impact of a QI initiative to reduce post‐caesarean opioid use. Design Retrospective cohort study. Setting Academic hospital in the USA. Population Women over 18 years undergoing caesarean section. Methods A quality improvement (QI) initiative titled Reduced Option for Opioid Therapy (ROOT) was implemented in women undergoing caesarean section. The intervention included implementation of a postpartum order set maximising the use of scheduled NSAIDs and acetaminophen. Additionally, nursing education promoted non‐opioid therapy as first‐line, with opioids reserved for breakthrough pain. Performance feedback was provided to nursing staff on a bimonthly basis. Post‐caesarean opioid use was reviewed in the 6 months before and after implementation of ROOT. Main outcome measures The primary outcome was the total morphine milligram equivalents (MME) consumed during the postpartum admission. Secondary outcomes included opioid use per postoperative day, the proportion of opioid‐free admissions, the percentage of patients discharged with a prescription for opioids, prescription size, and pain scores. Results Following implementation of ROOT, median inpatient opioid use decreased by more than 60%, from 75 to 30 MME per admission (P