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<0.0001) in pain‐related residual PIPs. A significant decreasing time trend was observed during the post‐implementation period. Post‐implementation, 1683 recommendations were given over one 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.
from Wiley: European Journal of Pain: Table of Contents https://ift.tt/36wJJw5
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