Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
Pharmacy Department, University Hospitals Leuven, Leuven, Belgium.
Eur J Pain. 2021 Mar;25(3):704-713. doi: 10.1002/ejp.1705. Epub 2020 Dec 11.
Pain therapy in inpatients is regularly suboptimal and might be improved by clinical pharmacy services. In our hospital, we have implemented a software-supported 'Check of Medication Appropriateness' (CMA), which is a centralized pharmacist-led service consisting of a clinical rule-based screening for potentially inappropriate prescriptions (PIPs), and a subsequent medication review by pharmacists. We aimed to investigate the impact of the CMA on pain-related prescribing.
A quasi-experimental study was performed in a large teaching hospital, using an interrupted time series design. Pre-implementation, patients were exposed to standard of care. Afterwards, a pain-focused CMA comprising 12 specific clinical rules pertaining to analgesic prescribing were implemented in the post-implementation period. A regression model was used to assess the impact of the intervention on the number of pain-related residual PIPs between both periods. The total number of recommendations and acceptance rate was recorded for the post-implementation period.
At baseline, a median number of 13.1 (range: 9.5-15.8) residual PIPs per day was observed. After the CMA intervention, the number was reduced to 2.2 (range: 0-9.5) per day. Clinical rules showed an immediate relative reduction of 66% (p < .0001) in pain-related residual PIPs. A significant decreasing time trend was observed during the post-implementation period. Post-implementation, 1683 recommendations were given over 1 year with an acceptance rate of 74.3%.
We proved that the CMA approach reduced the number of pain-related residual PIPs. More pharmacist involvement and the use of clinical rules during hospital stay should be further promoted to optimize appropriate prescribing of analgesics.
Prescribing of analgesics should be improved in inpatients to optimize pain control and to reduce iatrogenic harm. The Check of Medication Appropriateness (CMA) approach, comprising a clinical rule-based screening for patients at risk and a targeted medication review by pharmacists, reduced the number of pain-related potentially inappropriate prescriptions in a highly significant and sustained manner. This study presents the opportunities of a centralized clinical pharmacy service to help clinicians to further improve analgesic prescribing.
住院患者的疼痛治疗通常不尽如人意，可以通过临床药学服务来改善。在我们医院，我们实施了一种软件支持的“药物适宜性检查”（CMA），这是一项集中式的药师主导的服务，包括基于临床规则的潜在不适当处方（PIP）筛查，以及随后由药师进行的药物审查。我们旨在研究 CMA 对疼痛相关处方的影响。
在一家大型教学医院进行了一项准实验研究，使用中断时间序列设计。在实施前，患者接受标准护理。之后，在实施后阶段实施了一项以疼痛为重点的 CMA，其中包括 12 项与镇痛处方相关的特定临床规则。使用回归模型评估干预对两个时期之间疼痛相关剩余 PIP 数量的影响。记录实施后期间的建议总数和接受率。
在基线时，每天观察到中位数为 13.1（范围：9.5-15.8）个残留 PIP。在 CMA 干预后，数量减少到每天 2.2（范围：0-9.5）个。临床规则显示疼痛相关残留 PIP 立即相对减少 66%（p<.0001）。在实施后期间观察到显著的时间下降趋势。实施后，在 1 年内提出了 1683 项建议，接受率为 74.3%。
我们证明了 CMA 方法减少了疼痛相关残留 PIP 的数量。应进一步促进更多药师的参与和在住院期间使用临床规则，以优化镇痛药的适当处方。
应改善住院患者的镇痛药处方，以优化疼痛控制并减少医源性伤害。CMA 方法，包括对有风险的患者进行基于临床规则的筛查以及由药师进行有针对性的药物审查，以高度显著和持续的方式减少了疼痛相关潜在不适当处方的数量。这项研究展示了集中式临床药学服务的机会，可以帮助临床医生进一步改善镇痛药处方。
