Effect of an electronic medical record design modification on laxative co-prescribing among hospitalised patients taking opioids: A before-and-after study

Shania Liu; Danijela Gnjidic; Asad E Patanwala; George Rubin; Manuel Nielsen; Jonathan Penm

doi:10.1016/j.ijmedinf.2020.104172

Effect of an electronic medical record design modification on laxative co-prescribing among hospitalised patients taking opioids: A before-and-after study

Int J Med Inform. 2020 Aug:140:104172. doi: 10.1016/j.ijmedinf.2020.104172. Epub 2020 May 15.

Authors

Shania Liu¹, Danijela Gnjidic², Asad E Patanwala³, George Rubin⁴, Manuel Nielsen⁴, Jonathan Penm³

Affiliations

¹ The University of Sydney, Faculty of Medicine & Health, School of Pharmacy, Sydney, NSW, Australia; The University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia. Electronic address: sliu9823@uni.sydney.edu.au.
² The University of Sydney, Faculty of Medicine & Health, School of Pharmacy, Sydney, NSW, Australia; The University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia.
³ The University of Sydney, Faculty of Medicine & Health, School of Pharmacy, Sydney, NSW, Australia.
⁴ South Eastern Sydney Local Health District, NSW, Australia.

PMID: 32473568
DOI: 10.1016/j.ijmedinf.2020.104172

Abstract

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.

Keywords: Adverse drug event; Electronic health records; Inpatients; Laxatives; Opioid analgesics.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Analgesics, Opioid / administration & dosage*
Analgesics, Opioid / adverse effects
Australia / epidemiology
Constipation / chemically induced
Constipation / epidemiology
Constipation / prevention & control*
Drug Combinations
Electronic Health Records
Female
Hospitalization
Humans
Inpatients
Laxatives / therapeutic use*
Male
Middle Aged
Practice Patterns, Physicians'
Research Design*
Retrospective Studies

Substances

Analgesics, Opioid
Drug Combinations
Laxatives