Quality Improvement Efforts to Reduce Opioid Prescribing From a Pediatric Emergency Department

Since the early 1990s, the United States has been fighting the epidemic of opioid addiction. Increases in the prescription of over-the-counter opioid pain medications were correlated with a notable rise in overdose deaths as early as 1999.¹ These trends may have been driven in part by national efforts to improve the assessment and management of pain among patients and the “pain as a fifth vital sign” culture.² In this issue of Pediatrics, Bryl et al³ describe their quality improvement (QI) initiative to decrease prescription of opioid medications at discharge from their urban pediatric emergency department. Evaluation of data showing that nearly half of the opioid-related deaths among patients 0 to 21 years in the San Diego area involved patients seen at their institution prompted a call to action. As the largest pediatric provider in that region, achieving a decrease in the group’s prescription of opioid medications could have a significant impact on this population.

The team used rigorous QI methods to guide their initiative. These included developing a specific …

Address correspondence to Jacqueline B. Corboy, MD, MS, Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, 225 East Chicago Ave, Box 62, Chicago, IL 60611-2991. E-mail: jcorboy{at}luriechildrens.org