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Focus groups, Implementation, Nurse staffing, Nursing, Opioid, Postpartum



  1. Jun, Jin PhD, RN
  2. Sturza, Marisa MD
  3. Maguire, Sarah DNP, CNM
  4. Waljee, Jennifer MD
  5. Smith, Roger MD
  6. Peahl, Alex MD, MSc


Purpose: Opioid-sparing protocols have significantly reduced opioid use postcesarean birth through maximizing nonpharmacologic and nonopioid pain management tools. This study explored nurses' experiences with an opioid-sparing protocol at a single institution, where inpatient opioid prescribing was reduced by over half.


Method: Focus groups were used to identify key facilitators and barriers to implementation of the opioid-sparing protocol. The Consolidated Framework for Implementation Research (CFIR) guided data collection and analysis. Focus groups were recorded, transcribed, thematically coded, and analyzed for barriers and facilitators using predetermined CFIR domains.


Results: Three focus groups of nurses who care for women during postpartum were conducted in March and April 2019. Fourteen nurses participated. They were all women, with an average of 9.3 years (SD = 5.4) of maternity nursing experience. Facilitators of implementation were: 1) high satisfaction with the intervention's efficacy; 2) awareness of opioid harms promoting readiness for opioid-sparing efforts; 3) adequate staffing and the culture of evidence-based practice; and 4) bedside skills in pain management to identify patients' needs. The most significant barrier was a lack of nurse engagement with protocol development and implementation.


Clinical Implications: An increased partnership among the interprofessional team members through all stages of implementation is necessary for the success and sustainability of best patient care practices.