Charlotte Quintens1,2, Johan De Coster3, Lorenz Van der Linden1,2, Bart Morlion4, Egon Nijns5, Bart Van den Bosch5,6, Willy E Peetermans7,8, Isabel Spriet1,2. 1. Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium. 2. Pharmacy Department, University Hospitals Leuven, Leuven, Belgium. 3. Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium. 4. Leuven Centre for Algology & Pain Management, University Hospitals Leuven, KU Leuven, Leuven, Belgium. 5. Department of Information Technology, University Hospitals Leuven, Leuven, Belgium. 6. Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium. 7. Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium. 8. Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium.
Abstract
BACKGROUND: Pain therapy in inpatients is regularly suboptimal and might be improved by clinical pharmacy services. In our hospital, we have implemented a software-supported 'Check of Medication Appropriateness' (CMA), which is a centralized pharmacist-led service consisting of a clinical rule-based screening for potentially inappropriate prescriptions (PIPs), and a subsequent medication review by pharmacists. We aimed to investigate the impact of the CMA on pain-related prescribing. METHODS: A quasi-experimental study was performed in a large teaching hospital, using an interrupted time series design. Pre-implementation, patients were exposed to standard of care. Afterwards, a pain-focused CMA comprising 12 specific clinical rules pertaining to analgesic prescribing were implemented in the post-implementation period. A regression model was used to assess the impact of the intervention on the number of pain-related residual PIPs between both periods. The total number of recommendations and acceptance rate was recorded for the post-implementation period. RESULTS: At baseline, a median number of 13.1 (range: 9.5-15.8) residual PIPs per day was observed. After the CMA intervention, the number was reduced to 2.2 (range: 0-9.5) per day. Clinical rules showed an immediate relative reduction of 66% (p < .0001) in pain-related residual PIPs. A significant decreasing time trend was observed during the post-implementation period. Post-implementation, 1683 recommendations were given over 1 year with an acceptance rate of 74.3%. CONCLUSIONS: We proved that the CMA approach reduced the number of pain-related residual PIPs. More pharmacist involvement and the use of clinical rules during hospital stay should be further promoted to optimize appropriate prescribing of analgesics. SIGNIFICANCE: Prescribing of analgesics should be improved in inpatients to optimize pain control and to reduce iatrogenic harm. The Check of Medication Appropriateness (CMA) approach, comprising a clinical rule-based screening for patients at risk and a targeted medication review by pharmacists, reduced the number of pain-related potentially inappropriate prescriptions in a highly significant and sustained manner. This study presents the opportunities of a centralized clinical pharmacy service to help clinicians to further improve analgesic prescribing.
BACKGROUND:Pain therapy in inpatients is regularly suboptimal and might be improved by clinical pharmacy services. In our hospital, we have implemented a software-supported 'Check of Medication Appropriateness' (CMA), which is a centralized pharmacist-led service consisting of a clinical rule-based screening for potentially inappropriate prescriptions (PIPs), and a subsequent medication review by pharmacists. We aimed to investigate the impact of the CMA on pain-related prescribing. METHODS: A quasi-experimental study was performed in a large teaching hospital, using an interrupted time series design. Pre-implementation, patients were exposed to standard of care. Afterwards, a pain-focused CMA comprising 12 specific clinical rules pertaining to analgesic prescribing were implemented in the post-implementation period. A regression model was used to assess the impact of the intervention on the number of pain-related residual PIPs between both periods. The total number of recommendations and acceptance rate was recorded for the post-implementation period. RESULTS: At baseline, a median number of 13.1 (range: 9.5-15.8) residual PIPs per day was observed. After the CMA intervention, the number was reduced to 2.2 (range: 0-9.5) per day. Clinical rules showed an immediate relative reduction of 66% (p < .0001) in pain-related residual PIPs. A significant decreasing time trend was observed during the post-implementation period. Post-implementation, 1683 recommendations were given over 1 year with an acceptance rate of 74.3%. CONCLUSIONS: We proved that the CMA approach reduced the number of pain-related residual PIPs. More pharmacist involvement and the use of clinical rules during hospital stay should be further promoted to optimize appropriate prescribing of analgesics. SIGNIFICANCE: Prescribing of analgesics should be improved in inpatients to optimize pain control and to reduce iatrogenic harm. The Check of Medication Appropriateness (CMA) approach, comprising a clinical rule-based screening for patients at risk and a targeted medication review by pharmacists, reduced the number of pain-related potentially inappropriate prescriptions in a highly significant and sustained manner. This study presents the opportunities of a centralized clinical pharmacy service to help clinicians to further improve analgesic prescribing.
Authors: Erinn D'hulster; Charlotte Quintens; Jeroen Luyten; Raf Bisschops; Rik Willems; Willy E Peetermans; Jan Y Verbakel Journal: Int J Clin Pharm Date: 2022-01-11
Authors: Charlotte Quintens; Willy E Peetermans; Lorenz Van der Linden; Peter Declercq; Bart Van den Bosch; Isabel Spriet Journal: BMC Med Inform Decis Mak Date: 2022-07-05 Impact factor: 3.298
Authors: Charlotte Quintens; Marie Coenen; Peter Declercq; Minne Casteels; Willy E Peetermans; Isabel Spriet Journal: BMJ Open Date: 2022-04-08 Impact factor: 2.692