Disclosures: Steven M. Markos, MD: Nothing to disclose

Objective: Randomized clinical trials have demonstrated that scheduled high-dose acetaminophen (SHDA) decreases post-operative pain and opioid consumption; however, this is not yet common knowledge or practice. Our objective was to design an intervention for physical medicine and rehabilitation residents and fellows that increases their likelihood of prescribing SHDA for patients in acute rehabilitation with post-operative pain.

Design: Matched pairs, comparing responses to questions and tasks before and after intervention.

Setting: An academic rehabilitation hospital.

Participants: 16 participants (14 residents, 2 fellows).

Interventions: On day one, participants received a case vignette of a patient being admitted to acute rehabilitation with severe post-operative pain status-post lumbar laminectomy and completed an admission medication reconciliation task. Next, participants completed a pre-test on acetaminophen knowledge and attitudes. Participants then reviewed an original one-page informational brochure on SHDA for post-operative pain, and then a similar post-test was administered. After 2 weeks, participants were given the same case vignette with medication reconciliation task and post-test.

Main Outcome Measures: The main outcome measures were 1) participant prescription of SHDA (presence versus absence of 3-4 grams) on the medication reconciliation task and 2) self-rated future likelihood (5-point Likert scale) to prescribe SHDA, before versus after the intervention.

Results: Following the intervention, participants were significantly more likely (P<.001) to prescribe SHDA on the medication reconciliation task (0/16 before versus 8/16 after intervention). Comparing the pre-test and post-tests, participants’ self-rated likelihood to prescribe SHDA for future patients with post-operative pain in acute rehabilitation significantly increased after intervention, both at day one (P=.001) and 2 weeks follow-up (P=.003).

Conclusions: This quality improvement project established an effective, quick, and zero-cost intervention to promote evidence-based practices. With further validation, these intervention materials can be used across all practice settings to help physiatrists decrease pain and opioid consumption in post-operative patients, which is crucial for optimizing patients’ functional gains and length of stay in acute rehabilitation centers.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/reducing-post-operative-pain-and-opioid-consumption-through-evidence-based-medicine-an-educational-quality-improvement-project/