Split Scripts for Pediatric Supracondylar Fracture Repairs

Study Overview
=================
Brief Summary
-----------------
This study is designed to test the hypothesis that increased electronic order-set compliance and focused education will decrease the amount of unconsumed opioid entering and remaining in the home after pediatric supracondylar fracture repair The proposed study will address the hypothesis with the following objectives: investigators will increase compliance with previously implemented standardized precision-based electronic discharge order sets; investigators will introduce part-fill opioid prescriptions for supracondylar fracture repairs; investigators will increase parental compliance with home administration of simple (non-opioid) analgesics; investigators will decrease opioid amount remaining in the home pre and post 3-week follow up.

Detailed Description
-----------------
Canada has one of the highest opioid prescribing rates in the world (United Nations, 2018). In 2017, Health Quality Ontario published a major report that identified the number of opioid prescriptions following surgery were second only to those following dentist office visits. As a result, Health Quality Ontario made the reduction of opioid prescribing ('Cut the Count)' their number one provincial healthcare priority of 2019. To date, investigators have decreased MME amount of opioid entering the home post-supracondylar fracture repair at approximately 10 MME per patient and increased the rate of return of unused drug by 10 MME per patient. The Hospital for Sick Children alone performs some 200 such surgeries per year, representing 4,000 mg of morphine (four grams) that the community is no longer exposed to. This is only one surgery type in one hospital; expansion of our methodology to other surgeries (currently expanding to dental and cleft palates) and other institutions will dramatically decrease unintentional but iatrogenic home exposure of children and families to unwarranted and dangerous drugs. This latest study aims to address all three steps outlined in the 2020-2021 Health Quality Ontario surgical mandate for children discharged from The Hospital for Sick Children after supracondylar fracture repair.

Official Title
-----------------
PROSPR: PeriopeRative Opioid Stewardship Program of Research (Phase 4 Split Script Study)

Conditions
-----------------
Pain, Postoperative

Intervention / Treatment
-----------------
* Drug: Morphine


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients with Type II or Type III supracondylar fractures undergoing surgical wire placement or pinning that return to fracture clinic at three weeks for removal of pins/wires. Exclusion Criteria: Patients who are not prescribed morphine following a supracondylar fracture repair surgery

Ages Eligible for Study
-----------------
Minimum Age: 1 Month
Maximum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Split Script<br>Participants will receive four doses initially, with opportunity to obtain four additional doses if required | Drug: Morphine<br>* Children will be provided with morphine for at-home pain management following supracondylar fracture repair<br>* Other names: Opioid;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Amount of morphine milligram equivalents (MME) used at home per SCF patient between July 2022 and October 2023 | Recording of how much morphine (mgs or doses) was used at home following supracondylar fracture repair surgery | 3 days following discharge from hospital | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compliance with orders for home use of acetaminophen and ibuprofen per SCF patient between July 2022 and October 2023 | Recording of whether Tylenol and Advil were used at-home following supracondylar fracture repair surgery | 3 days following discharge from hospital | 
| Amount of morphine milligram equivalents (MME) returned to pharmacy per SCF patient between July 2022 and October 2023 | Recording of how much morphine was returned to the hospital pharmacy | 3 weeks following discharge (aligns with pin/wire removal at fracture clinic) | 
| Healthcare provider compliance to discharge order set | Recording of how often healthcare providers deviate from the standardized electronic discharge order set | Up to 100 weeks |