Effect of pharmacist education and intervention on ketorolac prescribing in an emergency department

Abstract

Background Pharmacists serve many important roles within the emergency department (ED) and frequently provide education on medications to clinicians and patients. Following a study that demonstrated a potential “analgesic ceiling” effect with ketorolac and suggested that doses lower than 30 mg IV may be effective, we implemented a reduced‐dose ketorolac pathway in our institution’s ED. Aim To assess the impact pharmacist education and on‐shift, active interventions had on ED clinicians' IV ketorolac prescribing habits. Method This was a retrospective, quasi‐experimental study conducted to evaluate the effect of a brief pharmacist‐led educational email intervention on ketorolac prescribing habits within an ED at a large, academic medical center. All orders of IV ketorolac for adult patients in the ED 180 days prior to and following the educational email were included in the analysis. Results Prior to the educational effort, 30 mg IV doses of ketorolac were most frequently ordered (n = 1772). However, following the educational effort, significantly fewer orders were for the 30 mg dose (n = 718) and the majority of orders were for 15 mg IV (n = 2081; p < 0.00001), consistent with the teaching from the intervention. Conclusion In this study, a significant prescribing practice change was facilitated by pharmacist‐led email education supported by on‐shift active guidance for clinicians by pharmacists.