Best Practice Alerts Informed by Inpatient Opioid Intake to Reduce Opioid Prescribing after Surgery (PRIOR): A Cluster Randomized Multiple Crossover Trial.
Best Practice Alerts Informed by Inpatient Opioid Intake to Reduce Opioid Prescribing after Surgery (PRIOR): A Cluster Randomized Multiple Crossover Trial.
复制标题
通过住院患者阿片类药物摄入量来减少手术后阿片类药物处方的最佳实践警报（之前）：集群随机多次交叉试验。
DOI：
10.1097/aln.0000000000004607
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发表时间：
2023
期刊：
影响因子：
8.8
通讯作者：
Bartels,Karsten
中科院分区：
文献类型：
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作者：
Rolfzen,MeganL;Wick,Abraham;Mascha,EdwardJ;Shah,Karan;Krause,Martin;Fernandez-Bustamante,Ana;Kutner,JeanS;Ho,PMichael;Sessler,DanielI;Bartels,Karsten
背景手术后阿片类药物的过度处方仍然很常见。残留的和不必要的处方阿片类药物可以为非医疗用途提供储存库。因此，我们测试的假设，即嵌入在电子健康记录的决策支持工具指导临床医生在出院后，住院surgery.MethodsWe研究了21，689外科住院病人出院的群集随机多交叉试验从2020年7月至2021年6月在四个科罗拉多医院。医院级集群被随机分配到交替的八周期间，在此期间，电子决策支持工具根据先前的住院阿片类药物摄入量推荐量身定制的出院阿片类药物处方。在主动警报期间，当建议的阿片类药物处方超过推荐量时，向临床医生显示警报。在非活动期间不显示警报。通过包括4周洗脱期减轻残留效应。主要结果是出院时处方的口服吗啡毫克当量。次要结局包括阿片类药物/非阿片类药物联合处方和额外的阿片类药物处方，直至出院后第28天。一个强有力的全州范围内的阿片类药物教育和认识运动是在地方在trial.ResultsThe总出院后阿片类药物处方是一个中位数[四分位数] 75 [0，225]口服吗啡毫克当量11，003例患者出院时，警报活跃和100 [0，225]吗啡毫克当量10，686例患者时，警报不活跃，几何平均值的估计比值为0.95（95% CI：0.80，1.13; P = 0.586）。在主动警报期内，28%（3，074/11，003）的出院患者显示警报。警报和规定的阿片类药物/非阿片类药物的组合药物或额外的阿片类药物处方出院后写的dispens.ConclusionsA决策支持工具纳入电子病历没有减少出院阿片类药物处方的背景下，大力阿片类药物的教育和宣传工作的术后患者之间没有关系。阿片类药物处方警报在其他情况下可能也有价值。在ClinicalTrials.gov注册（NCT 04446975）。
BackgroundOver-prescription of opioids after surgery remains common. Residual and unnecessarily prescribed opioids can provide a reservoir for nonmedical use. We therefore tested the hypothesis that a decision-support tool embedded in electronic health records guides clinicians to prescribe fewer opioids at discharge after inpatient surgery.MethodsWe studied 21,689 surgical inpatient discharges in a cluster randomized multiple crossover trial from July 2020 to June 2021 in four Colorado hospitals. Hospital-level clusters were randomized to alternating eight-week periods during which an electronic decision-support tool recommended tailored discharge opioid prescriptions based on prior inpatient opioid intake. During active alert periods, the alert was displayed to clinicians when the proposed opioid prescription exceeded recommended amounts. No alerts were displayed during inactive periods. Carryover effects were mitigated by including 4-week washout periods. The primary outcome was oral morphine milligram equivalents prescribed at discharge. Secondary outcomes included combination opioid/non-opioid prescriptions and additional opioid prescriptions until day 28 after discharge. A vigorous state-wide opioid education and awareness campaign was in place during the trial.ResultsThe total postdischarge opioid prescription was a median [quartiles] of 75 [0, 225] oral morphine milligram equivalents among 11,003 patients discharged when the alerts were active and 100 [0, 225] morphine milligram equivalents in 10,686 patients when the alerts were inactive, with an estimated ratio of geometric means of 0.95 (95% CI: 0.80, 1.13; P = 0.586). The alert was displayed in 28% (3,074/11,003) of the discharges during the active alert period. There was no relationship between the alert and prescribed opioid/non-opioid combination medications or additional opioid prescriptions written after discharge.ConclusionsA decision-support tool incorporated into electronic medical records did not reduce discharge opioid prescribing for postoperative patients in the context of vigorous opioid education and awareness efforts. Opioid prescribing alerts might yet be valuable in other contexts. Registered at ClinicalTrials.gov (NCT04446975).