Analgesic Prescribing Practices Can Be Improved by Low-Cost Point-of-Care Decision Support
Analgesic Prescribing Practices Can Be Improved by Low-Cost Point-of-Care Decision Support
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DOI：
10.1016/j.jpainsymman.2011.01.008
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发表时间：
2011-10-01
影响因子：
4.7
通讯作者：
Auerbach, Andrew D.
中科院分区：
文献类型：
--
作者：
Rosenbluth, Glenn;Wilson, Stephen D.;Auerbach, Andrew D.
上下文。与其他常用药物相比，可待因已成为儿童止痛的一种有争议的选择。评估教育活动是否改变了居民的处方模式，从可待因转向更合适的镇痛剂。我们的干预措施包括向住院儿科急性护理病房的所有实习生和主要工作人员发放一张袖珍大小的参考卡；儿科住院医生也可以选择参加一小时的讲座。这张袖珍卡片建议不要服用可待因(包括基本原理)，并为我们机构首选的处方替代止痛药(包括曲马多和氢可酮)提供了处方指南。我们使用住院患者的处方数据来跟踪一段时间内可待因和替代药物的处方情况。干预后，接受可待因治疗的患者比例显著下降(13.5%的患者在前一年接受治疗，5.4%在后一年接受治疗，P<；0.0001)。在同一时期，含氢可酮的镇痛剂的使用总体上增加了(7.4%-16%，P<；0.0001)，曲马多的使用也增加了(0.2%-2.6%，P<；0.0001)。疼痛管理满意度评分无明显变化。一个简单的低成本教育活动，主要是由止痛药袖珍指南组成的，显著改善了止痛药的处方模式，这种改进延伸到了我们教育活动的说教部分没有针对的服务。通过袖珍卡片提供的医疗保健决策支持可能足以改变受训人员的用药模式。J疼痛症状管理2011；42：623-631。(C)2011年美国癌症疼痛缓解委员会。爱思唯尔公司出版，版权所有。
Context. Codeine has become a controversial choice for analgesia in children compared with other commonly available drugs.Objectives. To evaluate whether an educational campaign shifted resident prescribing patterns away from codeine toward more appropriate analgesics.Methods. Our intervention consisted of a pocket-sized reference card given to all trainees and key staff in an inpatient pediatric acute care unit; pediatrics residents also had the option to attend a one-hour lecture. The pocket card recommended against codeine (including rationale) and gave prescription guidance for our institution's preferred formulary alternative analgesics, which include tramadol and hydrocodone. We used inpatient prescribing data to track the prescribing of codeine and alternative medications over time.Results. Following the interventions, there was a significant decrease in the percentage of patients receiving codeine (13.5% of patients received the drug in the year before, 5.4% in the year after, P < 0.0001). Use of hydrocodone-containing analgesics increased overall during the same period (7.4%-16%, P < 0.0001) as did tramadol use (0.2%-2.6%, P < 0.0001). There were no changes in pain management satisfaction scores.Conclusion. A simple low-cost educational campaign consisting primarily of a pocket guide to analgesics markedly improved analgesic prescribing patterns, and that improvement extended to services not targeted by the didactic component of our educational campaign. Point-of-care decision support by means of a pocket card may be sufficient for effecting change in medication prescribing patterns of trainees. J Pain Symptom Manage 2011;42:623-631. (C) 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.