(1032) Implementation of a Multimodal Pain Order Set in Adult Burn Patients

Introduction: Burn injuries can be one the most painful experiences with detrimental long-term effects when inadequately treated. The 2018 SCCM and 2020 ABA guidelines recommend a multimodal approach to pain management comprised of both opioids and non-opioids. Currently, there are two retrospective cohort studies in adults following a burn injury, which found a decrease in opioid consumption following a multimodal regimen. Despite current guidelines, there is still limited literature on how this is effectively done. The purpose of this study was to compare outcomes before and after implementation of a multimodal pain order set in the burn admission order set within the electronic medical record.

Methods: This single center, retrospective, cohort study was conducted at an ABA-verified burn center, where a multimodal pain management order set was implemented in June 2021. The primary outcome was daily morphine milligram equivalents (MME) received on days one, three, and seven from admission and cumulative MMEs through day seven. One of our secondary outcomes included evidence of pain, defined as a Critical-Care Pain Observation Tool (CPOT) score greater than two or verbal pain scale greater than three on days one, three, and seven from admission.

Results: The pre-group (n = 64) and post-group (n = 63) were well-matched with respect to baseline demographics, such as total body surface area, length of stay, mechanical ventilation, and number of procedures. There was a significant reduction in cumulative MMEs received between groups (172 versus 97, p = 0.042) without worsening evidence of pain. Scheduled acetaminophen (62.5% versus 95.2%, p < 0.001), scheduled nonsteroidal anti-inflammatory drugs (31.3% versus 42.9%, p = 0.017), and ketamine (14.1% versus 28.6%, p = 0.043) received were significantly increased in the post-group.

Conclusions: Our study observed a significant reduction in cumulative MMEs received through admission day seven following order set implementation. This order set significantly improved guideline-recommended multimodal analgesic use and increased non-opioid analgesic use. Other sites would benefit from additional studies of a similar order set to increase the use of non-opioid alternatives for pain management following a burn injury.