Cultivating optimal analgesic prescribing practices in a metropolitan hospital network: evaluating an analgesic stewardship program

IF 1 Q4 PHARMACOLOGY & PHARMACY

Journal of Pharmacy Practice and Research Pub Date : 2024-03-26 DOI:10.1002/jppr.1914

Jeremy Szmerling BPharm (Hons), GradCertPharmPrac, ANZCAP-Reg (PainMgmt, Steward), Sam Maleki BPharm, MPharmPrac, FANZCAP (OncHaem, Research), Gordon Mar BA, MB, Mmed, FANZCA, Anne Goulopoulos BPharm(Hons), GradCertPharmPrac, MClinPharm, AdvPracPharm, FANZCAP (Lead&Mgmt)

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引用次数: 0

Abstract

Background

The increasing incidence of opioid-related harm associated with inappropriate opioid prescription underscores the need for effective interventions directed at enhancing analgesic prescribing practices. Analgesic stewardship (AGS) programs have emerged to facilitate appropriate analgesic use, reducing analgesic-related harm and optimising patient outcomes.

Aim

This study aimed to assess the impact of an AGS program on the appropriateness of opioid analgesia prescribing for adult inpatients within a metropolitan health network during the initial two months following program implementation.

Method

This retrospective audit examined de-identified aggregate data of 100 adult inpatients of a major Australian metropolitan hospital network between August–September 2022. The multidisciplinary AGS program involving pharmacy, nursing, and medical staff provided clinical interventions and recommendations for patients, supported by organisational interventions, including education and guideline reinforcement. Data collection included patient demographics, clinical data, and AGS program recommendations documented in patient medical records. Ethical approval was granted by the Eastern Health Office of Research and Ethics (Reference no: QA23-015-91886) and the study confirms to the Australian Statement on Ethical Conduct in Human Research.

Results

It was found that 51% of opioid-naïve patients were prescribed modified-release opioids for acute non-cancer pain, contrary to local guidelines. The AGS program recommendations resulted in an 89.7% cessation of these prescriptions. For non-opioid-naïve patients, there was a statistically significant reduction in mean Oral Morphine Equivalent Daily Dose of 19.85 mg (95% confidence interval [CI] 10.3–29.4 mg, p < 0.05). AGS recommendations were predominantly adhered to, with 82% showing full or partial compliance.

Conclusion

This study highlights the positive impact of an AGS program on the appropriateness of opioid analgesic prescribing for adult inpatients. These findings support the implementation of AGS programs into healthcare systems to mitigate opioid-related harm and improve patient outcomes.

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在大都市医院网络中培养最佳镇痛处方实践：评估镇痛管理计划

与阿片类药物处方不当有关的阿片类药物相关伤害的发生率不断上升，这突出表明需要采取有效的干预措施来加强镇痛处方的使用。镇痛管理（AGS）项目的出现旨在促进镇痛药的合理使用，减少与镇痛药相关的伤害并优化患者的治疗效果。本研究旨在评估一项AGS项目在项目实施后最初两个月内对某大都市医疗网络内成人住院患者阿片类镇痛药处方合理性的影响。这项回顾性审计检查了澳大利亚某大都市医院网络在2022年8月至9月期间100名成人住院患者的去标识化汇总数据。由药剂师、护理人员和医护人员参与的多学科 AGS 计划为患者提供临床干预和建议，并辅以组织干预，包括教育和指南强化。数据收集包括患者的人口统计学特征、临床数据以及患者病历中记录的 AGS 计划建议。该研究获得了东部卫生研究与伦理办公室的伦理批准（编号：QA23-015-91886），并符合《澳大利亚人类研究伦理行为声明》。研究发现，51%的阿片类药物无效患者在治疗急性非癌性疼痛时被开具了改良缓释阿片类药物处方，这与当地的指导方针相悖。根据 AGS 计划的建议，89.7% 的患者停用了这些处方。非阿片类药物过敏患者的平均每日口服吗啡当量减少了 19.85 毫克（95% 置信区间 [CI] 10.3-29.4 毫克，P < 0.05），这在统计学上具有显著意义。这项研究强调了 AGS 计划对成人住院患者阿片类镇痛药处方适当性的积极影响。这些研究结果支持在医疗系统中实施 AGS 计划，以减轻阿片类药物相关的伤害并改善患者的治疗效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Pharmacy Practice and Research Health Professions-Pharmacy

CiteScore

1.60

自引率

9.50%

发文量

期刊介绍： The purpose of this document is to describe the structure, function and operations of the Journal of Pharmacy Practice and Research, the official journal of the Society of Hospital Pharmacists of Australia (SHPA). It is owned, published by and copyrighted to SHPA. However, the Journal is to some extent unique within SHPA in that it ‘…has complete editorial freedom in terms of content and is not under the direction of the Society or its Council in such matters…’. This statement, originally based on a Role Statement for the Editor-in-Chief 1993, is also based on the definition of ‘editorial independence’ from the World Association of Medical Editors and adopted by the International Committee of Medical Journal Editors.