Discharge narcotic prescribing and management practices at pediatric trauma centers in the United States
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In brief
In brief
National survey of 92 pediatric trauma centers reveals lack of standardization in discharge opioid prescribing and patient education practices. Most centers have no formal protocols to reduce narcotic quantities or train staff in nonpharmacological pain management, highlighting critical gaps in addressing pediatric opioid safety.
Written by the GCMD Library team from the article.
Introduction
Trauma is the leading cause of mortality among children in the US. Injured children often receive narcotic pain medication throughout their hospital stays and upon discharge from pediatric trauma centers. While effective, narcotics carry significant risks. There is a dearth of knowledge regarding narcotic education, prescribing practices, and pain management training at pediatric trauma centers. We hypothesize that there is a lack of standardization in these practices among pediatric trauma centers nationally.
Methods
A national survey was sent to medical directors at ACS-verified and state designated level 1 and 2 pediatric trauma centers. Data were collected over 6 months on discharge narcotic education and prescribing practices.
Results
Of 97 surveys sent, 92 were returned (94.8% response). Responses show that narcotics are most commonly prescribed by residents (79.1%). Electronic Medical Record (EMR) prescribing is common (89.2%); however, only 1.75% of EMRs give recommendation to prescribe naloxone. Only 9.7% report a standardized format of narcotic education. Most healthcare staff providing narcotic education receive no training in nonpharmacological pain management (68.8%). Most centers report no formal process to reduce the quantity of discharge narcotics prescribed (71.0%). Respondents report many barriers to providing discharge narcotic education to patients and families, including staff training on how to provide discharge narcotic education, staff availability, patient/ parent literacy, and format of available educational resources.
Conclusion
The study results show that there is lack of standardization in discharge narcotic education and prescription practices among pediatric trauma facilities nationally and highlight the need for a standardized narcotic prescribing and management protocol. Despite the growing national concern of opiate misuse, particularly among children, respondents report inability to deliver adequate narcotic education owing to various communication and systems barriers.
Type of study
Cross-sectional survey.
Level of evidence
Level IV.