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New protocol for cesarean mothers post-op at Cleveland Clinic uses opioids as secondary medication

Posted: 10:56 AM, Jun 06, 2019
Updated: 2019-06-07 14:07:13Z
Cleveland Clinic

FAIRVIEW PARK. OHIO — This week in Columbus, the Ohio Patient Safety Institute gave Fairview Hospital a Best Practice Award for their efforts in the fight against the opioid epidemic.

"We wanted to make sure our patient's pain was well controlled, appropriately, and that they wouldn't be subject to the risks of addiction," said Dr. Eric Chiang, director of the Western Sector for the Anesthesiology Institute at Cleveland Clinic.

Doctor Chiang led a pilot program at Fairview Hospital that looked at the use of opioids for cesarean patients after surgery.

He says they focused on Obstetrics and cesareans because c-sections are the most common, major in-patient surgery in the United States. He says about 1.2 million are preformed every year.

"If you calculate that to about 1 in 300 mothers who studies show potentially become addicted or chronic users of narcotics after a c-section, that's about 4,000 people per year in this country," explained Dr. Chiang.

Traditionally, he says patients are given opioids after their c-section and sent home with a prescription.

The pilot program focused on offering the opioids only if non-narcotic pain medications given first were not enough.

All c-section patients are given Tylenol and Motrin, alternating every three hours. The women can ask for the opioid pain killer if they want or need it.

Doctor Chiang says when patients were given the choice, they saw a 70 percent drop in opioids used after c-section.

They have also reduced the number of narcotic pills a woman is prescribed when going home.

If the patient didn't use opioids during their hospital stay, they won't be discharged with a prescription for them.

Those who did, will now only be sent home with five pills.

"The overall number of pills coming out of our OB floor here for patients to go home with has decreased by almost 90 percent," said Dr. Chiang.

He says the new guidelines better protect patients and the community.

"Mothers need to know that we as doctors always take their pain very seriously, but narcotics are not the primary pain medicine and never should be," he said.

He says they are also looking to apply this philosophy to other areas of general surgery.

The new guidelines are underway at all Cleveland Clinic birthing centers except Akron General, which Dr. Chiang says will come online soon.