临床决策支持警报,以促进及时使用泻药的住院患者处方氯氮平。

IF 3.9 3区 医学 Q1 PSYCHIATRY
BJPsych Open Pub Date : 2025-03-13 DOI:10.1192/bjo.2025.1
Milan Sundermann, Susanna Every-Palmer, Murray Barclay, Paul K L Chin
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引用次数: 0

摘要

背景:氯氮平引起的胃肠功能低下和便秘可导致严重的,有时是致命的胃肠道并发症。泻药应与氯氮平一起预防性处方,但这是不一致的。数字临床决策支持(CDS)警报可以促进更安全的处方。目的:评价CDS预警是否能促进医院及时使用氯氮平泻药。方法:采用回顾性住院患者处方数据,比较1194家使用氯氮平的住院患者在预警前(2017年1月- 2019年9月)和预警后(2019年9月- 2023年12月)首次使用氯氮平处方时共开泻药的情况。评估常规非膨化泻药和首次氯氮平处方24小时内的任何泻药合用。采用多变量逻辑回归来确定警报执行对泻药联合处方的影响。结果:纳入的1194例患者中,449例患者在预警前实施氯氮平处方,745例患者在预警后实施氯氮平处方。在氯氮平首次处方中,预警前和预警后分别有67.0%和76.1%的患者同时服用常规非膨化泻药(P < 0.001)。预警前和预警后分别有87.3%和96.5%的氯氮平首次处方同时使用泻药(P < 0.001)。警惕性执行与常规非膨化泻药联合处方的可能性增加相关(优势比,1.341;95% ci, 1.021-1.756;P = 0.035)和任何共开泻药处方(优势比,3.487;95% ci, 2.135-5.838;P < 0.001)。结论:CDS警报的实施与氯氮平合并泻药处方的增加和早期相关。我们的研究结果表明,CDS警报是促进医院及时使用氯氮平泻药的有效工具。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A clinical decision support alert to promote timely laxative use in in-patients prescribed clozapine.

Background: Clozapine-induced gastrointestinal hypomotility and constipation can result in severe and sometimes fatal gastrointestinal complications. Laxatives should be prophylactically prescribed with clozapine, but this is inconsistently achieved. Digital clinical decision support (CDS) alerts can promote safer prescribing.

Aims: To evaluate whether a CDS alert could promote timely laxative use with clozapine in hospital.

Method: Retrospective in-patient prescribing data was used to compare co-prescribing of laxatives for first clozapine prescriptions pre-alert (January 2017-September 2019) and post-alert (September 2019-December 2023) implementation across 1194 hospital admissions where clozapine was prescribed. Regular non-bulking laxative and any laxative co-prescribing for first clozapine prescriptions within 24 h were assessed. Multivariable logistic regression was performed to determine the impact of alert implementation on laxative co-prescribing.

Results: Of the 1194 admissions included, 449 admissions had clozapine prescribed pre-alert implementation and 745 admissions had post-alert implementation. Regular non-bulking laxative co-prescription occurred for 67.0% of first clozapine prescriptions pre-alert and 76.1% post-alert (P < 0.001). Any laxative co-prescription occurred for 87.3% of first clozapine prescriptions pre-alert and 96.5% post-alert (P < 0.001). Alert implementation was associated with increased likelihoods of regular non-bulking laxative co-prescribing (odds ratio, 1.341; 95% CI, 1.021-1.756; P = 0.035) and any laxative co-prescribing (odds ratio, 3.487; 95% CI, 2.135-5.838; P < 0.001) for first clozapine prescriptions within 24 h.

Conclusions: CDS alert implementation was associated with increased and earlier laxative co-prescribing for clozapine. Our findings suggest that a CDS alert is an effective tool for promoting timely laxative use with clozapine in hospital.

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来源期刊
BJPsych Open
BJPsych Open Medicine-Psychiatry and Mental Health
CiteScore
6.30
自引率
3.70%
发文量
610
审稿时长
16 weeks
期刊介绍: Announcing the launch of BJPsych Open, an exciting new open access online journal for the publication of all methodologically sound research in all fields of psychiatry and disciplines related to mental health. BJPsych Open will maintain the highest scientific, peer review, and ethical standards of the BJPsych, ensure rapid publication for authors whilst sharing research with no cost to the reader in the spirit of maximising dissemination and public engagement. Cascade submission from BJPsych to BJPsych Open is a new option for authors whose first priority is rapid online publication with the prestigious BJPsych brand. Authors will also retain copyright to their works under a creative commons license.
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