The University of Sydney, Faculty of Medicine & Health, School of Pharmacy, Sydney, NSW, Australia; The University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia.
The University of Sydney, Faculty of Medicine & Health, School of Pharmacy, Sydney, NSW, Australia; The University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia.
Int J Med Inform. 2020 Aug;140:104172. doi: 10.1016/j.ijmedinf.2020.104172. Epub 2020 May 15.
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.
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.
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.
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.
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.
在使用阿片类镇痛药的住院患者中，多达 71.7%（33/46）发生便秘。建议同时开具缓泻剂来预防阿片类药物引起的便秘。
本研究旨在探讨电子病历（EMR）设计修改以增加住院使用阿片类镇痛药患者同时开具缓泻剂的效果。
在这项回顾性的 3 个月前后研究中，于 2018 年 2 月 21 日在澳大利亚悉尼的一所教学医院实施了一项 EMR 修改，以提高地衣芽孢杆菌和双八面体蒙脱石散医嘱的可见性。主要结局是在首次给予阿片类镇痛药后 24 小时内同时开具地衣芽孢杆菌和双八面体蒙脱石散的比例。从 EMR 中收集国际疾病分类第 10 次修订版澳大利亚修改诊断代码。采用多变量逻辑回归分析 EMR 修改对阿片类镇痛药与缓泻剂同时开具的影响。
本研究纳入了 1832 名成年住院患者（51.0%为男性），其中 50.5%在 EMR 修改实施前入院，49.5%在实施后入院。在 EMR 修改实施前，有 12.5%的患者同时开具了地衣芽孢杆菌和双八面体蒙脱石散，而在实施后，有 14.9%的患者同时开具了该药物。尽管 EMR 修改并没有改变手术患者的缓泻剂同时开具情况（比值比 [OR] = 1.1，95%置信区间 [CI] 0.8-1.6，p = 0.54），但在老年护理患者中，地衣芽孢杆菌和双八面体蒙脱石散同时开具的比例显著增加（OR = 1.8，95%CI 1.0-3.0，p = 0.03）。
EMR 设计修改并没有改变住院患者总体的缓泻剂同时开具情况。然而，EMR 修改与老年护理患者中阿片类镇痛药处方同时开具缓泻剂的显著增加有关。
