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New Protocols for Prescribing Pain Meds to New Moms Cut Opioid Use

May 3, 2018

AUSTIN, Texas — Dell Medical School at The University of Texas at Austin and Seton Healthcare Family are making strides in curbing opioid use by new mothers with a new, two-step process that has decreased the use of opioids for postpartum pain by more than 40 percent.

The changes, which involved how pain is assessed and how medication is prescribed, were used in more than 7,300 OB-GYN patients across all Seton hospitals since February 2017.

“The No. 1 cause of accidental maternal mortality within one year of delivery in Texas is drug overdose, and the majority of those deaths involve prescription opiates,” said Amy Young, M.D., chair of the Department of Women’s Health at Dell Med and head of Women’s Health at Seton, part of Ascension. “We have a specific duty to address this problem so moms can be healthy at a time in their lives when they arguably need to be their healthiest,” she said.

Dependence on opioids — which include illegal drugs such as heroin and legal drugs such as fentanyl, oxycodone, codeine and morphine — is a national health crisis responsible for more than 115 Americans dying every day, according to the National Institute on Drug Abuse.

A Patient-Centered Approach to Prescribing Opioids
The first part of the new protocol focuses on how pain levels are assessed. Patients are asked whether they can achieve a therapeutic activity goal — specifically, whether they can rest comfortably and go to the bathroom without pain. If not, their pain is considered to be inadequately controlled.

In contrast, the traditional method is highly subjective: the patient points to a drawing of a face on a chart reflecting her level of pain — known as the Wong-Baker FACES scale.

“We wanted to come up with an individualized, goal-directed therapeutic plan to help the moms through their hospital stay and afterward — one that uses an objective method to quantify pain and a more organized plan to treat it,” says Dell Med Assistant Professor and Seton anesthesiologist Chad Dieterichs, M.D., who helped develop the new pain protocols.

The second part is called multimodal pain therapy. The patient begins with a combination of acetaminophen and ibuprofen dosed to maximize her therapeutic potential. If she can’t meet her therapeutic activity goal (go to the bathroom and rest comfortably) on the first level of medication, she receives additional medicines as needed to control pain and meet goals.

Using satisfaction surveys, clinicians monitored how effectively patients’ pain was controlled. Results show that pain levels have been consistently well managed with the new initiative.

“In the past, patients who said they were in pain would be started on narcotics from the get-go,” Young said. “But we’ve found that most women we treat can meet their functional goal without using opioids.”

The Relief of Avoiding Opioid Side Effects
Aside from wanting to avoid the risk of addiction, moms have a wide range of reasons for not wanting to take opioids. Wanting to be clear headed, responsive and not under the influence while trying to care for a newborn is just one of them, according to Young. Common side effects of opioid use include sedation, dizziness, nausea, vomiting, constipation and physical dependence.

“I’m not a big medication person, so it’s comforting to know you’re just on Tylenol,” said Jamie Moxham, mother of two who delivered her second baby using the new pain protocol at Seton Medical Center Austin.

When Moxham delivered her first baby under traditional pain protocols at a different hospital, she recalls being given a morphine pump in the hospital and being prescribed an acetaminophen-opioid combination drug for when she returned home. The latter resulted in severe constipation.

“It was the worst experience, especially knowing that I probably didn’t need the drug in the first place,” Moxham said.

The new pain protocol was first tested on knee surgery patients, then expanded to OB-GYN patients, and Young says the program has now been implemented for all Seton patients. The success has caught the attention of other Texas hospitals and throughout Ascension, which is moving to adopt the plan across its network.