Context

Constipation occurs in up to 71.7% (33/46) of hospital inpatients taking opioid analgesics. Co-prescribing laxatives with opioid analgesics is recommended to prevent opioid-induced constipation.

Objectives

This study aimed to examine the effect of an electronic medical record (EMR) design modification to increase laxative co-prescribing among hospitalised inpatients taking opioid analgesics.

Methods

In this retrospective 3-month before-and-after study, an EMR modification to improve docusate with sennosides order sentence visibility was implemented on 21 February 2018, at a teaching hospital in Sydney, Australia. The primary outcome was the co-prescription rate of docusate with sennosides within 24-h of the first opioid analgesic administered. International Classification of Diseases 10th Revision Australian Modification diagnosis codes were collected from the EMR. Multivariable logistic regression was performed to determine the impact of the EMR modification on co-prescribing of laxatives with opioid analgesics.

Results

Of the 1832 adult inpatients included in the study (51.0% male), 50.5% were admitted before the EMR modification implementation and 49.5% were admitted afterwards. Docusate with sennosides was co-prescribed in 12.5% of patients before and 14.9% of patients after the EMR modification. Although the EMR modification did not change laxative co-prescribing among surgical patients (odds ratio [OR] = 1.1, 95% confidence interval [CI] 0.8–1.6, p = 0.54), a significant increase in co-prescription of docusate with sennosides among aged care patients (OR = 1.8, 95% CI 1.0–3.0, p = 0.03) was observed.

Conclusions

An EMR design modification did not change laxative co-prescribing in hospital inpatients overall. However, the EMR modification was associated with a significant increase in laxative co-prescribing among aged care patients prescribed opioid analgesics.

中文翻译：

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电子病历设计修改对服用阿片类药物的住院患者通便处方的影响：一项前后研究。

语境

服用阿片类镇痛药的住院患者中，多达71.7％（33/46）出现便秘。建议与阿片类镇痛药合用的泻药，以防止阿片类药物引起的便秘。

目标

这项研究旨在检查电子病历（EMR）设计修改的效果，以增加服用阿片类镇痛药的住院患者的缓泻药处方。

方法

在这项为期3个月的回顾性前后研究中，于2018年2月21日在澳大利亚悉尼的一家教学医院实施了EMR修改，以改善人参皂甙命令句可见度的docusate。主要结局是在首次使用阿片类镇痛药后24小时内，多库酯与森诺糖苷的处方率相同。国际疾病分类第十次修订版澳大利亚修订诊断代码是从EMR中收集的。进行多变量logistic回归以确定EMR修饰对泻药与阿片类镇痛药共同处方的影响。

结果

在纳入研究的1832名成人住院患者中（男性为51.0％），在实施EMR之前入院率为50.5％，其后为49.5％。在EMR修改之前，12.5％的患者和14.9％的患者共同处方了多库酯和番石榴苷。尽管EMR修改并没有改变外科手术患者的缓泻药处方（奇数比[OR] = 1.1，95％置信区间[CI] 0.8-1.6，p = 0.54），但是多库酯与山参皂苷的联合处方显着增加在老年患者中（OR = 1.8，95％CI 1.0-3.0，p = 0.03）。

结论

总体上，EMR设计修改并没有改变缓泻药的共同处方。但是，EMR修改与处方阿片类镇痛药的老年护理患者泻药共同处方的显着增加有关。