Department of Surgery, University of California San Francisco School of Medicine, San Francisco, California, USA.
Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA.
J Hosp Med. 2023 Aug;18(8):685-692. doi: 10.1002/jhm.13153. Epub 2023 Jun 25.
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce pain and has become a core strategy to decrease opioid use, but there is a lack of data to describe encouraging use when admitting patients using electronic health record systems.
Assess an electronic health record system to increase ordering of NSAIDs for hospitalized adults.
DESIGNS, SETTINGS AND PARTICIPANTS: We performed a cluster randomized controlled trial of clinicians admitting adult patients to a health system over a 9-month period. Clinicians were randomized to use a standard admission order set.
Clinicians in the intervention arm were required to actively order or decline NSAIDs; the control arm was shown the same order but without a required response.
The primary outcome was NSAIDs ordered and administered by the first full hospital day. Secondary outcomes included pain scores and opioid prescribing.
A total of 20,085 hospitalizations were included. Among these hospitalizations, patients had a mean age of 58 years, and a Charlson comorbidity score of 2.97, while 50% and 56% were female and White, respectively. Overall, 52% were admitted by a clinician randomized to the intervention arm. NSAIDs were ordered in 2267 (22%) interventions and 2093 (22%) control admissions (p = .10). Similarly, there were no statistical differences in NSAID administration, pain scores, or opioid prescribing. Average pain scores (0-5 scale) were 3.36 in the control group and 3.39 in the intervention group (p = .46). There were no differences in clinical harms.
Requiring an active decision to order an NSAID at admission had no demonstrable impact on NSAID ordering. Multicomponent interventions, perhaps with stronger decision support, may be necessary to encourage NSAID ordering.
使用非甾体抗炎药（NSAIDs）可以减轻疼痛，已成为减少阿片类药物使用的核心策略，但在使用电子健康记录系统为患者办理入院手续时，缺乏鼓励使用 NSAIDs 的相关数据。
评估电子健康记录系统以增加为住院成人开具 NSAIDs 的医嘱。
设计、设置和参与者：我们对在 9 个月期间入院的成年患者进行了一项以临床医生为单位的聚类随机对照试验。临床医生被随机分配使用标准入院医嘱集。
干预组的临床医生需要主动开具或拒绝 NSAIDs；对照组显示相同的医嘱，但无需做出响应。
主要结局是在第一个完整住院日内开具和使用 NSAIDs 的情况。次要结局包括疼痛评分和阿片类药物的开具情况。
共纳入 20085 例住院患者。这些患者的平均年龄为 58 岁，Charlson 合并症评分为 2.97，分别有 50%和 56%为女性和白人。总体而言，52%的患者由随机分配到干预组的临床医生收治入院。在干预组的 2267 例（22%）和对照组的 2093 例（22%）入院中开具了 NSAIDs（p=0.10）。同样，在 NSAIDs 的使用、疼痛评分或阿片类药物的开具方面，也没有统计学差异。对照组的平均疼痛评分（0-5 分）为 3.36，干预组为 3.39（p=0.46）。两组在临床危害方面也没有差异。
在入院时要求对开具 NSAIDs 做出积极决策，并没有对 NSAIDs 的开具产生明显影响。可能需要多方面的干预措施，包括更有力的决策支持，才能鼓励开具 NSAIDs。
