Preventive Prescribing of Laxatives for Opioid-induced Constipation Using Electronic Clinical Rule Implementation by Cinical Pharmacists

Abstract

Objective: The objective of this study was: (1) to develop and validate an electronic clinical rule for ‘Opioid-Laxative Use’ and to implement this rule in clinical pharmacy practice; (2) to improve guideline compliance by using this refined clinical rule; and (3) to investigate if opioid-induced constipation (OIC) can be reduced in hospitalised patients by the application of this clinical rule. Methods: Interventions using clinical rule alerts were performed between June and September 2009. We compared guideline compliance before and after the intervention to determine the difference. Interventions consisted of telephone consultations by a clinical pharmacist advising physicians to add a laxative to opioid therapy. Patient files were matched to a historical control group using an opioid without a laxative to examine the difference between intervention- and control patients in the presence of OIC. Results: Prospective validation of the rule resulted in several refinements. In the intervention period, 140 alerts were generated, 60 of which (43%) led to co-prescription of a laxative. Therefore, guideline compliance increased from 70% to 83%. A significant difference in OIC was found between the intervention group (12%) and the control group (56%). Conclusions: This study showed that pharmacy intervention based on an electronic clinical rule for ´Opioid-Laxative Use´ led to more adequate co-prescription of opioids and laxatives. This led to a better compliance with the guideline as well as a better outcome, as measured by the significant decrease in the prevalence of OIC.