TY - JOUR
T1 - Effect of an electronic medical record design modification on laxative co-prescribing among hospitalised patients taking opioids
T2 - A before-and-after study
AU - Liu, Shania
AU - Gnjidic, Danijela
AU - Patanwala, Asad E.
AU - Rubin, George
AU - Nielsen, Manuel
AU - Penm, Jonathan
N1 - Funding Information:
This work was funded by The Inspiring Ideas Challenge 2017/18, South Eastern Sydney Local Health District . DG is supported by the Australian National Health and Medical Research Council Dementia Leadership Fellowship . The funding had no role in the design of the study, data collection and analysis, or preparation of the manuscript.
Funding Information:
This work was funded by The Inspiring Ideas Challenge 2017/18, South Eastern Sydney Local Health District. DG is supported by the Australian National Health and Medical Research Council Dementia Leadership Fellowship. The funding had no role in the design of the study, data collection and analysis, or preparation of the manuscript.
Publisher Copyright:
© 2020
PY - 2020/8
Y1 - 2020/8
N2 - Context: Constipation occurs in up to 71.7% (33/46) of hospital inpatients taking opioid analgesics. Co-prescribing laxatives with opioid analgesics is recommended to prevent opioid-induced constipation. Objectives: This study aimed to examine the effect of an electronic medical record (EMR) design modification to increase laxative co-prescribing among hospitalised inpatients taking opioid analgesics. Methods: In this retrospective 3-month before-and-after study, an EMR modification to improve docusate with sennosides order sentence visibility was implemented on 21 February 2018, at a teaching hospital in Sydney, Australia. The primary outcome was the co-prescription rate of docusate with sennosides within 24-h of the first opioid analgesic administered. International Classification of Diseases 10th Revision Australian Modification diagnosis codes were collected from the EMR. Multivariable logistic regression was performed to determine the impact of the EMR modification on co-prescribing of laxatives with opioid analgesics. Results: Of the 1832 adult inpatients included in the study (51.0% male), 50.5% were admitted before the EMR modification implementation and 49.5% were admitted afterwards. Docusate with sennosides was co-prescribed in 12.5% of patients before and 14.9% of patients after the EMR modification. Although the EMR modification did not change laxative co-prescribing among surgical patients (odds ratio [OR] = 1.1, 95% confidence interval [CI] 0.8–1.6, p = 0.54), a significant increase in co-prescription of docusate with sennosides among aged care patients (OR = 1.8, 95% CI 1.0–3.0, p = 0.03) was observed. Conclusions: An EMR design modification did not change laxative co-prescribing in hospital inpatients overall. However, the EMR modification was associated with a significant increase in laxative co-prescribing among aged care patients prescribed opioid analgesics.
AB - Context: Constipation occurs in up to 71.7% (33/46) of hospital inpatients taking opioid analgesics. Co-prescribing laxatives with opioid analgesics is recommended to prevent opioid-induced constipation. Objectives: This study aimed to examine the effect of an electronic medical record (EMR) design modification to increase laxative co-prescribing among hospitalised inpatients taking opioid analgesics. Methods: In this retrospective 3-month before-and-after study, an EMR modification to improve docusate with sennosides order sentence visibility was implemented on 21 February 2018, at a teaching hospital in Sydney, Australia. The primary outcome was the co-prescription rate of docusate with sennosides within 24-h of the first opioid analgesic administered. International Classification of Diseases 10th Revision Australian Modification diagnosis codes were collected from the EMR. Multivariable logistic regression was performed to determine the impact of the EMR modification on co-prescribing of laxatives with opioid analgesics. Results: Of the 1832 adult inpatients included in the study (51.0% male), 50.5% were admitted before the EMR modification implementation and 49.5% were admitted afterwards. Docusate with sennosides was co-prescribed in 12.5% of patients before and 14.9% of patients after the EMR modification. Although the EMR modification did not change laxative co-prescribing among surgical patients (odds ratio [OR] = 1.1, 95% confidence interval [CI] 0.8–1.6, p = 0.54), a significant increase in co-prescription of docusate with sennosides among aged care patients (OR = 1.8, 95% CI 1.0–3.0, p = 0.03) was observed. Conclusions: An EMR design modification did not change laxative co-prescribing in hospital inpatients overall. However, the EMR modification was associated with a significant increase in laxative co-prescribing among aged care patients prescribed opioid analgesics.
KW - Adverse drug event
KW - Electronic health records
KW - Inpatients
KW - Laxatives
KW - Opioid analgesics
UR - http://www.scopus.com/inward/record.url?scp=85085252857&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85085252857&partnerID=8YFLogxK
U2 - 10.1016/j.ijmedinf.2020.104172
DO - 10.1016/j.ijmedinf.2020.104172
M3 - Article
C2 - 32473568
AN - SCOPUS:85085252857
SN - 1386-5056
VL - 140
JO - International Journal of Medical Informatics
JF - International Journal of Medical Informatics
M1 - 104172
ER -