Preventing Excess Narcotic Prescriptions in New Robotic Surgery Discharges: The PENN Prospective Cohort Quality Improvement Initiative

2020 ◽  
Vol 34 (1) ◽  
pp. 48-53 ◽  
Author(s):  
Ruchika Talwar ◽  
Leilei Xia ◽  
Juan Serna ◽  
James Ding ◽  
Daniel J. Lee ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Robotic Surgery ◽  
Prospective Cohort ◽  
Quality Improvement Initiative ◽  
Cohort Quality

A Prospective Cohort Quality Improvement Study to Reduce the Time to Antibiotics for New Fever in Neutropenic Pediatric Oncology Inpatients

2015 ◽  
Vol 63 (1) ◽  
pp. 112-117 ◽  
Author(s):  
Adam L. Green ◽  
Joanna Yi ◽  
Natalie Bezler ◽  
Yana Pikman ◽  
Venée N. Tubman ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pediatric Oncology ◽  
Prospective Cohort ◽  
Time To Antibiotics ◽  
Cohort Quality

Preventing excess narcotic prescriptions in MIS urologic oncology discharges (PENN): A prospective cohort quality improvement initiative.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6502-6502
Author(s):  
Ruchika Talwar ◽  
Leilei Xia ◽  
Juan Serna ◽  
Daniel Lee ◽  
Justin Ziemba ◽  
...  
Keyword(s):  
Prospective Cohort ◽  
Oral Morphine ◽  
Quality Improvement Initiative ◽  
Robotic Partial Nephrectomy ◽  
Patient Centered ◽  
Urologic Oncology ◽  
Surgical Pain ◽  
Robotic Radical Nephrectomy ◽  
Cohort Quality ◽  
Standing Regimen

6502 Background: In the setting of the national opioid crisis, there is increasing interest in non-narcotic pain strategies, particularly for oncology patients. Robotic urologic surgeries for cancer have been shown to result in less pain than open approaches. We hypothesized that the majority of these patients could be safely discharged with adequate analgesia without opioids. Methods: This prospective cohort study aimed to reduce narcotics prescribed at discharge after robotic radical prostatectomy (RARP), robotic radical nephrectomy (RARN) and robotic partial nephrectomy (RAPN). Prior to 9/2018, 100% of patients were discharged on varying amounts of oxycodone (range: 75-337.5 oral morphine milligram equivalents [MME]). We implemented a standard non-opioid analgesia pathway with escalation options across the continuum of care. Patients received gabapentin 300 mg and acetaminophen 975 mg once PO pre-operatively, as well as gabapentin 300 mg every 8 hours, acetaminophen 975 mg every 8 hours PO, and ketorolac 15 mg every 6 hours IV post-operatively. If complaining of persistent pain despite the standing regimen, patients were given 50 mg or 100 mg of tramadol every 6 hours as needed for pain level 5-7 or 8-10 on the visual analog scale, respectively. If requiring further escalation, patients were given 5 or 10 mg of oxycodone every 6 hours as needed on the aforementioned scale. Regardless of escalation status, all patients were discharged on the standing non-narcotic protocol. If escalated, ten pills of tramadol 50 mg or oxycodone 5 mg were prescribed accordingly. Results: Our cohort (n = 170) consisted of patients undergoing RARP (n = 87), RARN (n = 25), RAPN (n = 58) between 9/1/2018-1/9/2019. Overall, 67.7% were discharged without opioids, 24.4% with ten pills of tramadol 50 mg (50 MME) and 8.2% with ten pills of oxycodone 5 mg (75 MME). On multivariate analysis, older age (OR: 0.961, 95% CI: 0.923-0.995, p = 0.026) was associated with lower odds of needing opioids at discharge. There was no difference in postoperative telephone encounters between those discharged with or without opioids. Conclusions: The majority of robotic surgery patients do not require opioids upon discharge. An escalation protocol allows for a patient centered approach to reduce narcotic prescribing while still addressing cancer and surgical pain.

Implementing a Quality Improvement Initiative for Asthma Management in a Tribal Clinic

2005 ◽  
Author(s):  
Charlanne J. FitzGerald ◽  
Beverly Hart ◽  
Adrienne Laverdure ◽  
Brian Schafer
Keyword(s):  
Quality Improvement ◽  
Asthma Management ◽  
Quality Improvement Initiative

A Patient-Driven Quality Improvement Initiative for Pituitary Adenoma Care

2020 ◽  
Author(s):  
Irene Druce ◽  
Mary-Anne Doyle ◽  
Amel Arnaout ◽  
Dora Liu ◽  
Fahad Alkherayf ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pituitary Adenoma ◽  
Quality Improvement Initiative

1209-P: A Quality Improvement Initiative to Increase Utilization of Continuous Glucose Monitors Results in Improved Glycemic Outcomes in a Pediatric Diabetes Clinic

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1209-P
Author(s):  
KATHRYN OBRYNBA ◽  
JUSTIN A. INDYK ◽  
KAJAL GANDHI ◽  
DON A. BUCKINGHAM ◽  
TRAVIS WELLS ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Improvement Initiative ◽  
Diabetes Clinic ◽  
Pediatric Diabetes ◽  
Continuous Glucose Monitors ◽  
Glycemic Outcomes
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