A behavioral intervention to promote use of multimodal pain medication for hospitalized patients: A randomized controlled trial

Abstract

Background The use of nonsteroidal anti‐inflammatory drugs (NSAIDs) can reduce pain and has become a core strategy to decrease opioid use, but there is a lack of data to describe encouraging use when admitting patients using electronic health record systems. Objective Assess an electronic health record system to increase ordering of NSAIDs for hospitalized adults. Designs, Settings and Participants We performed a cluster randomized controlled trial of clinicians admitting adult patients to a health system over a 9‐month period. Clinicians were randomized to use a standard admission order set. Intervention Clinicians in the intervention arm were required to actively order or decline NSAIDs; the control arm was shown the same order but without a required response. Main Outcome and Measures The primary outcome was NSAIDs ordered and administered by the first full hospital day. Secondary outcomes included pain scores and opioid prescribing. Results A total of 20,085 hospitalizations were included. Among these hospitalizations, patients had a mean age of 58 years, and a Charlson comorbidity score of 2.97, while 50% and 56% were female and White, respectively. Overall, 52% were admitted by a clinician randomized to the intervention arm. NSAIDs were ordered in 2267 (22%) interventions and 2093 (22%) control admissions (p = .10). Similarly, there were no statistical differences in NSAID administration, pain scores, or opioid prescribing. Average pain scores (0–5 scale) were 3.36 in the control group and 3.39 in the intervention group (p = .46). There were no differences in clinical harms. Conclusions and Relevance Requiring an active decision to order an NSAID at admission had no demonstrable impact on NSAID ordering. Multicomponent interventions, perhaps with stronger decision support, may be necessary to encourage NSAID ordering.

Electronic health record intervention to increase use of NSAIDs as analgesia for hospitalised patients: a cluster randomised controlled study

“…[6][7][8][9] However, clinical decision support can add complexity and workflow tasks that contribute to clinician burn-out, and it needs to be justified in terms of clinical benefit. In a previous study, 10 we tested whether requiring an active choice for NSAID ordering (a 'hard stop') in the pain management order panel in our standard admission order set changed NSAID prescribing, but we found this approach to be ineffective. Specifically, NSAIDs were ordered in 22% of the intervention arm and 22% of the control arm (p=0.10 accounting for clustering).…”

“…In a previous study, 10 we tested whether requiring an active choice for NSAID ordering (a ‘hard stop’) in the pain management order panel in our standard admission order set changed NSAID prescribing, but we found this approach to be ineffective. Specifically, NSAIDs were ordered in 22% of the intervention arm and 22% of the control arm (p=0.10 accounting for clustering).…”