Division of Pediatric Hospital Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA.
J Pain Symptom Manage. 2011 Oct;42(4):623-31. doi: 10.1016/j.jpainsymman.2011.01.008. Epub 2011 Mar 31.
Codeine has become a controversial choice for analgesia in children compared with other commonly available drugs.
To evaluate whether an educational campaign shifted resident prescribing patterns away from codeine toward more appropriate analgesics.
Our intervention consisted of a pocket-sized reference card given to all trainees and key staff in an inpatient pediatric acute care unit; pediatrics residents also had the option to attend a one-hour lecture. The pocket card recommended against codeine (including rationale) and gave prescription guidance for our institution's preferred formulary alternative analgesics, which include tramadol and hydrocodone. We used inpatient prescribing data to track the prescribing of codeine and alternative medications over time.
Following the interventions, there was a significant decrease in the percentage of patients receiving codeine (13.5% of patients received the drug in the year before, 5.4% in the year after, P < 0.0001). Use of hydrocodone-containing analgesics increased overall during the same period (7.4%-16%, P < 0.0001) as did tramadol use (0.2%-2.6%, P < 0.0001). There were no changes in pain management satisfaction scores.
A simple low-cost educational campaign consisting primarily of a pocket guide to analgesics markedly improved analgesic prescribing patterns, and that improvement extended to services not targeted by the didactic component of our educational campaign. Point-of-care decision support by means of a pocket card may be sufficient for effecting change in medication prescribing patterns of trainees.
与其他常用药物相比，可待因在儿童中的镇痛效果引发了争议。
评估教育活动是否改变住院医师对可待因的处方模式，使其偏向更合适的镇痛药物。
我们的干预措施包括为住院儿科急性护理病房的所有受训者和关键人员发放袖珍参考卡；儿科住院医师还可以选择参加一个小时的讲座。袖珍卡片建议不要使用可待因（包括理由），并为我们机构首选的处方替代镇痛药提供处方指导，其中包括曲马多和氢可酮。我们使用住院患者的处方数据来跟踪随时间推移可待因和替代药物的处方情况。
干预措施实施后，接受可待因治疗的患者比例显著下降（在干预前一年有 13.5%的患者接受该药物治疗，而在干预后一年则为 5.4%，P < 0.0001）。同期，含氢可酮的镇痛药物的使用总体增加（7.4%-16%，P < 0.0001），曲马多的使用也增加（0.2%-2.6%，P < 0.0001）。疼痛管理满意度评分没有变化。
一项主要由镇痛药袖珍指南组成的简单、低成本教育活动显著改善了镇痛药物的处方模式，而且这种改善延伸到了我们教育活动的教学部分未涉及的服务。通过袖珍卡进行即时决策支持可能足以改变受训者的药物处方模式。
