Electronic health record intervention to increase use of NSAIDs as analgesia for hospitalised patients: a cluster randomised controlled study

IF 4.1 Q1 HEALTH CARE SCIENCES & SERVICES BMJ Health & Care Informatics Pub Date : 2023-12-01 DOI:10.1136/bmjhci-2023-100842
Tasce Bongiovanni, Mark J Pletcher, Andrew Robinson, Elizabeth Lancaster, Li Zhang, Matthias Behrends, Elizabeth Wick, Andrew Auerbach
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Abstract

Background Prescribing non-opioid pain medications, such as non-steroidal anti-inflammatory (NSAIDs) medications, has been shown to reduce pain and decrease opioid use, but it is unclear how to effectively encourage multimodal pain medication prescribing for hospitalised patients. Therefore, the aim of this study is to evaluate the effect of prechecking non-opioid pain medication orders on clinician prescribing of NSAIDs among hospitalised adults. Methods This was a cluster randomised controlled trial of adult (≥18 years) hospitalised patients admitted to three hospital sites under one quaternary hospital system in the USA from 2 March 2022 to 3 March 2023. A multimodal pain order panel was embedded in the admission order set, with NSAIDs prechecked in the intervention group. The intervention group could uncheck the NSAID order. The control group had access to the same NSAID order. The primary outcome was an increase in NSAID ordering. Secondary outcomes include NSAID administration, inpatient pain scores and opioid use and prescribing and relevant clinical harms including acute kidney injury, new gastrointestinal bleed and in-hospital death. Results Overall, 1049 clinicians were randomised. The study included 6239 patients for a total of 9595 encounters. Both NSAID ordering (36 vs 43%, p<0.001) and administering (30 vs 34%, p=0.001) by the end of the first full hospital day were higher in the intervention (prechecked) group. There was no statistically significant difference in opioid outcomes during the hospitalisation and at discharge. There was a statistically but perhaps not clinically significant difference in pain scores during both the first and last full hospital day. Conclusions This cluster randomised controlled trial showed that prechecking an order for NSAIDs to promote multimodal pain management in the admission order set increased NSAID ordering and administration, although there were no changes to pain scores or opioid use. While prechecking orders is an important way to increase adoption, safety checks should be in place. Data are available in a public, open access repository. Data is publicly available from the Centers of Medicare and Medicaid Services from the US Government.
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电子健康记录干预增加住院病人使用非甾体抗炎药镇痛:分组随机对照研究
背景开具非阿片类止痛药(如非甾体类抗炎药)已被证明可以减轻疼痛并减少阿片类药物的使用,但如何有效鼓励为住院患者开具多模式止痛药尚不清楚。因此,本研究旨在评估预先检查非阿片类止痛药医嘱对临床医生为住院成年人开具非甾体抗炎药处方的影响。方法 这是一项分组随机对照试验,研究对象是 2022 年 3 月 2 日至 2023 年 3 月 3 日期间在美国一家四级医院系统下的三家医院住院的成人(≥18 岁)住院患者。入院医嘱中嵌入了一个多模式疼痛医嘱面板,干预组预先勾选了非甾体抗炎药。干预组可以取消对非甾体抗炎药单的勾选。对照组可使用相同的非甾体抗炎药单。主要结果是增加了非甾体抗炎药的订购量。次要结果包括非甾体抗炎药的使用、住院患者疼痛评分、阿片类药物的使用和处方,以及相关的临床危害,包括急性肾损伤、新发消化道出血和院内死亡。结果 共有 1049 名临床医生接受了随机治疗。研究共涉及 6239 名患者,共计 9595 次就诊。干预(预先检查)组的非甾体抗炎药订购率(36% 对 43%,P<0.001)和住院第一天结束时的用药率(30% 对 34%,P=0.001)均高于干预(预先检查)组。住院期间和出院时的阿片类药物治疗效果在统计学上没有明显差异。住院第一天和最后一天的疼痛评分在统计学上有显著差异,但临床意义不大。结论 这项分组随机对照试验表明,在入院医嘱中预先核对非甾体抗炎药的医嘱以促进多模式疼痛管理,可以增加非甾体抗炎药的医嘱和用药量,但疼痛评分或阿片类药物的使用没有变化。虽然预先检查医嘱是提高采用率的重要方法,但安全检查也应到位。数据可在公开、开放的资料库中获取。数据由美国政府医疗保险和医疗补助服务中心公开提供。
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CiteScore
6.10
自引率
4.90%
发文量
40
审稿时长
18 weeks
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