VUMC testing tool that predicts opioid needs after cesarean section

Vanderbilt University Medical Center researchers are developing a clinical decision support tool to help avoid over- and under-prescribing of opioids for women undergoing cesarean section.

Nearly a third of U.S. women will have a cesarean section during childbirth. However, opioid prescriptions for these new mothers often are either insufficient to meet their pain needs or amount to overkill.

Under a five-year grant from the National Institute on Drug Abuse, VUMC will collect data to identify factors associated with minimal or maximal opioid use that the tool will then leverage to predict individualized opioid needs based on patients’ clinical, demographic and behavioral characteristics.

According to Sarah Osmundson, MD, assistant professor of obstetrics and gynecology, opioid prescribing for women who have had a cesarean section is often based on prescriber habits rather than patient needs, with many prescribers sending women home with a 30-tablet prescription—regardless of their pain.

“The goal of a clinical support tool is to do that work for the providers,” says Osmundson. “It’s not feasible for a provider to count previous usage when they have 10 patients to see in one morning, so that’s when they default back to 30 tablets.”

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Vanderbilt Medical Center Campus photos, summer 2014 ( Daniel Dubois / Vanderbilt University)

Under the three-part study, data will be collected on how many opioids patients are using a Bluetooth-enabled cap that records each time a tablet is removed from a prescription bottle.

As part of the study’s third and final phase, the decision support tool will be evaluated against standard practices in a randomized clinical trial.

“I think some physicians have their own standard they’re used to prescribing or they tend to repeat what they learned in residency or from their superiors,” adds Osmundson. “We do a lot of prescribing that’s based on even or round numbers, like tens and fives. I think few physicians look at how much a patient has used in the hospital to make a decision.”

Ultimately, researchers contend that the clinical decision support tool will be integrated into VUMC’s Epic electronic health record to help prescribers optimize opioid prescriptions—by providing a recommended number of tablets—so they are tailored to individual needs.

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