Abstract
Routine use of opioids for inpatient pain management increased the risk of adverse events. Decreased respiratory quality and over sedation compromise a patient's ability to heal by increasing the risk of further complications. Patients with rib fractures are at an even greater risk for complications as their normal respiratory efforts are compromised due to underlying injury. In rib fracture patients the risk for infection, escalation of care, and hospital length of stay is largely dependent on the patients' ability to participate in pulmonary hygiene therapies. These therapies do not deliver optimal patient benefit without adequate pain control. Cautious use of opioids and inclusion of non-opioid therapies was identified as a priority goal for one hospital organization. Inpatient pain management order sets were revised within to limit the use of opioid analgesics and encourage use of non-opioid therapies at Methodist Medical Center in Des Moines, IA. Retrospective chart review enabled researchers to compare number of opioids ordered, number of opioids administered during the hospital stay (MME/day), incidence of naloxone use, and hospital length of stay before and after pain management order set changes were implemented. Statistically significant changes were not found between pre- and post-order set changes for amount of opioids received, incidence of naloxone use, and hospital length of stay. Statistically significant changes were found with fewer intravenous opioids having been administered on the medical/surgical units and within 24 hours of discharge.