Computerized physician order entry and decision support improves ED analgesic ordering for renal colic

Area of Science:

• Emergency Medicine
• Health Informatics
• Clinical Pharmacology

Background:

• Computerized physician order entry (CPOE) systems aim to improve patient care safety and efficiency.
• The impact of CPOE on clinical practice in emergency departments (EDs) remains variable.
• Specific evaluation of CPOE's effect on analgesic prescribing for renal colic is needed.

Purpose of the Study:

• To assess the influence of CPOE implementation on analgesic prescribing and dosing for patients with renal colic in the ED.
• To determine changes in the utilization of ketorolac, fentanyl, and morphine following CPOE adoption.

Main Methods:

• A retrospective pre/post comparative study design was employed across three tertiary hospitals.
• Two groups of 230 high-acuity renal colic patients were analyzed: pre-CPOE and post-CPOE implementation.
• Primary outcome: proportion of patients receiving ketorolac; Secondary outcomes: analgesic choice and average morphine dose.

Main Results:

• Ketorolac administration significantly increased post-CPOE (65.6% to 76.5%, P = .015).
• Fentanyl use also showed a significant rise (9.7% to 16.7%, P = .047).
• No statistically significant differences were observed in morphine use or average morphine dose.

Conclusions:

• CPOE implementation is associated with increased ketorolac utilization for ED renal colic presentations.
• This finding may be attributed to the inclusion of ketorolac in CPOE-specific order sets.
• Condition-specific electronic order sets integrated with CPOE can potentially promote evidence-based prescribing practices.