Electronic health record intervention to increase use of NSAIDs as analgesia for hospitalised patients: a cluster randomised controlled study.
Electronic health record intervention to increase use of NSAIDs as analgesia for hospitalised patients: a cluster randomised controlled study.
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DOI：
10.1136/bmjhci-2023-100842
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发表时间：
2023-12-30
影响因子：
4.1
通讯作者：
Auerbach, Andrew
中科院分区：
文献类型：
--
作者：
Bongiovanni, Tasce;Pletcher, Mark J.;Robinson, Andrew;Lancaster, Elizabeth;Zhang, Li;Behrends, Matthias;Wick, Elizabeth;Auerbach, Andrew
处方非阿片类止痛药物，例如非甾体抗炎 (NSAID) 药物，已被证明可以减轻疼痛并减少阿片类药物的使用，但尚不清楚如何有效鼓励住院患者开出多模式止痛药物。因此，本研究的目的是评估预先检查非阿片类止痛药处方对临床医生为住院成人开非甾体抗炎药的影响。这是一项整群随机对照试验，受试者为 2022 年 3 月 2 日至 2023 年 3 月 3 日期间在美国一个四级医院系统下的三个医院收治的成人（≥18 岁）住院患者。入院医嘱集中嵌入了多模式疼痛医嘱面板，干预组中预先检查了非甾体抗炎药。干预组可以取消选中 NSAID 订单。对照组获得相同的非甾体抗炎药订单。主要结果是非甾体抗炎药订购量的增加。次要结局包括非甾体抗炎药的使用、住院患者疼痛评分、阿片类药物的使用和处方以及相关的临床危害，包括急性肾损伤、新发胃肠道出血和院内死亡。总体而言，1049 名临床医生被随机分组。该研究纳入了 6239 名患者，总共进行了 9595 次就诊。干预（预先检查）组在第一个完整住院日结束时的 NSAID 订购率（36% vs 43%，p<0.001）和给药率（30% vs 34%，p=0.001）均较高。住院期间和出院时阿片类药物的结果没有统计学上的显着差异。在住院的第一天和最后一天，疼痛评分存在统计上但可能不具有临床显着性差异。这项整群随机对照试验表明，预先检查 NSAID 订单以促进入院订单集中的多模式疼痛管理会增加 NSAID 的订购和管理，尽管疼痛评分或阿片类药物的使用没有变化。虽然预先检查订单是提高采用率的重要方法，但安全检查也应该到位。
Prescribing non-opioid pain medications, such as non-steroidal anti-inflammatory (NSAIDs) medications, has been shown to reduce pain and decrease opioid use, but it is unclear how to effectively encourage multimodal pain medication prescribing for hospitalised patients. Therefore, the aim of this study is to evaluate the effect of prechecking non-opioid pain medication orders on clinician prescribing of NSAIDs among hospitalised adults. This was a cluster randomised controlled trial of adult (≥18 years) hospitalised patients admitted to three hospital sites under one quaternary hospital system in the USA from 2 March 2022 to 3 March 2023. A multimodal pain order panel was embedded in the admission order set, with NSAIDs prechecked in the intervention group. The intervention group could uncheck the NSAID order. The control group had access to the same NSAID order. The primary outcome was an increase in NSAID ordering. Secondary outcomes include NSAID administration, inpatient pain scores and opioid use and prescribing and relevant clinical harms including acute kidney injury, new gastrointestinal bleed and in-hospital death. Overall, 1049 clinicians were randomised. The study included 6239 patients for a total of 9595 encounters. Both NSAID ordering (36 vs 43%, p<0.001) and administering (30 vs 34%, p=0.001) by the end of the first full hospital day were higher in the intervention (prechecked) group. There was no statistically significant difference in opioid outcomes during the hospitalisation and at discharge. There was a statistically but perhaps not clinically significant difference in pain scores during both the first and last full hospital day. This cluster randomised controlled trial showed that prechecking an order for NSAIDs to promote multimodal pain management in the admission order set increased NSAID ordering and administration, although there were no changes to pain scores or opioid use. While prechecking orders is an important way to increase adoption, safety checks should be in place.
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影响因子：
39
作者：
McDonald EG;Wu PE;Rashidi B;Wilson MG;Bortolussi-Courval É;Atique A;Battu K;Bonnici A;Elsayed S;Wilson AG;Papillon-Ferland L;Pilote L;Porter S;Murphy J;Ross SB;Shiu J;Tamblyn R;Whitty R;Xu J;Fabreau G;Haddad T;Palepu A;Khan N;McAlister FA;Downar J;Huang AR;MacMillan TE;Cavalcanti RB;Lee TC
通讯作者：
Lee TC
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
5.9
作者：
Bates, DW;Kuperman, GJ;Tanasijevic, M
通讯作者：
Tanasijevic, M
影响因子：
105.7
作者：
Kwan, Janice L.;Lo, Lisha;Shojania, Kaveh G.
通讯作者：
Shojania, Kaveh G.
影响因子：
5.7
作者：
Silvestri, Mark T.;Xu, Xiao;Krumholz, Harlan M.
通讯作者：
Krumholz, Harlan M.