默认医嘱标准化对阿片类药物处方模式的影响。

Effect of Default Order Standardization on Opioid Prescribing Patterns.

出版信息

Jt Comm J Qual Patient Saf. 2021 Jul;47(7):431-437. doi: 10.1016/j.jcjq.2021.03.005. Epub 2021 Mar 13.

DOI:10.1016/j.jcjq.2021.03.005

Abstract

BACKGROUND

Opioid misuse, overprescribing, dependency, and overdose remains a significant concern in the United States. A quality improvement study was conducted at the University of Illinois Hospital & Health Sciences System to determine the effect of standardizing the default orders for hydrocodone-acetaminophen products implemented on June 22, 2016.

METHODS

Prior to the intervention, default orders had variable dose tablet numbers (1 or 2) and dosing frequencies (every 4 or 6 hours), and no default dispense quantity. Defaults were modified to 1 tablet every 6 hours as needed for pain and dispense quantities of 3 and 5 days' supply were added. Number of tablets per order, dosing frequency, and days' supply prescribed between January 1, 2016, and June 21, 2016, were compared to those placed between June 22, 2016, and December 31, 2016. Opioid doses were converted into morphine milligram equivalents (MME). Analyses were performed to determine the effect of the intervention on daily opioid dose and number of days' supply prescribed.

RESULTS

22,052 orders were included in this study. Following the intervention, the number of tablets prescribed was reduced by an average of 19,832 tablets per month. Every 6 hours dosing (as opposed to every 4 hours) increased by 21.52 percentage points. Prescriptions with ≥ 50 MME/day dropped by 5.8 percentage points, and > 3 days' supply decreased by 2.54 percentage points. Linear regression demonstrated an increase in opioid prescriptions with daily < 50 MME (odds ratio [OR] = 1.72, p < 0.001) and ≤ 3 days' supply (OR = 1.27, p < 0.001).

CONCLUSION

Default electronic health record settings strongly influence prescribing patterns.

摘要

背景

在美国，阿片类药物滥用、过度处方、依赖和过量用药仍然是一个严重的问题。伊利诺伊大学医院和健康科学系统进行了一项质量改进研究，以确定 2016 年 6 月 22 日实施的将氢可酮-对乙酰氨基酚产品的默认医嘱标准化的效果。

方法

在干预之前，默认医嘱的剂量有不同的片剂数量（1 或 2）和给药频率（每 4 或 6 小时），且没有默认的配药数量。默认医嘱被修改为每 6 小时按需服用 1 片，增加了 3 天和 5 天的供应配药量。比较了 2016 年 1 月 1 日至 6 月 21 日期间和 2016 年 6 月 22 日至 12 月 31 日期间的每张处方的片剂数量、给药频率和供应天数，并分析干预对规定的每日阿片类药物剂量和供应天数的影响。

结果

本研究共纳入 22052 张处方。干预后，每月处方中规定的片剂数量减少了 19832 片。每 6 小时（而非每 4 小时）给药的比例增加了 21.52 个百分点。每日剂量≥50MME 的处方减少了 5.8 个百分点，>3 天的供应减少了 2.54 个百分点。线性回归显示，每日<50MME（比值比[OR] = 1.72，p<0.001）和≤3 天供应的阿片类药物处方增加（OR = 1.27，p<0.001）。