Implementation of a Post Cesarean Multimodal Analgesic Order Set

Abstract

Problem: A community hospital with approximately 200 elective cesarean deliveries annually did not have a standard order set for multimodal pain management of parturients after elective cesarean section with spinal anesthetic, resulting in high reliance on postoperative opioid use. Purpose: The purpose of this quality improvement project was to create and implement an evidence-based, multimodal analgesic order set for use following spinal anesthetic for elective cesarean delivery. Methods: A literature review was completed to identify evidence-based best practices for multimodal analgesic regimens after elective cesarean delivery with spinal anesthetic. Information was shared with site stakeholders including nursing, pharmacy, informatics, obstetrics, and anesthesiology teams. A protocol was drafted, approved, and implemented. Compliance with placing the order set for appropriate patients was tracked and communicated to stakeholders on a weekly basis. An education email was provided to the anesthesia department between weeks two and three of the project. Results: During the first two weeks after the go-live date, no anesthesia providers utilized spinal anesthetics for parturients undergoing elective cesarean section, and therefore, order set utilization was also zero. During weeks three through fifteen, eighteen patients received spinal anesthesia for elective cesarean section and compliance with utilizing the post-operative order set was one hundred percent. Conclusions: The project supported reduction of institutional reliance on postoperative opioids, as the order set provides patients with scheduled non-opioid analgesics. High compliance with the intervention suggests the implementation was successful.