Successful de-implementation of an ineffective practice: The fall of docusate

Area of Science:

• Pharmacoeconomics
• Health Services Research
• Clinical Quality Improvement

Background:

• Docusate, a widely prescribed laxative, demonstrates a lack of treatment efficacy.
• Reducing wasteful medical practices is crucial for optimizing healthcare value.
• This project focused on de-implementing docusate in favor of evidence-based alternatives.

Purpose of the Study:

• To de-implement the use of ineffective docusate in inpatient settings.
• To introduce and promote an evidence-based constipation order set.
• To optimize medication value by reducing wasteful prescribing.

Main Methods:

• An ambidirectional study analyzed inpatient laxative orders from 2018 to 2022.
• Docusate prescription data was stratified by service and unit for targeted de-implementation.
• An evidence-based constipation order set was integrated into the electronic health record (Cerner).

Main Results:

• Over 700,000 docusate orders were recorded across numerous services and units.
• Docusate administration rates exceeded those of other laxatives.
• Docusate orders decreased by 44% within 4 months, while polyethylene glycol (PEG) and senna orders increased by 58% and 35%, respectively.

Conclusions:

• Docusate lacks efficacy but remains widely prescribed.
• A structured de-implementation strategy, utilizing technology and multidisciplinary efforts, can drive systematic change.
• This initiative successfully removed docusate from the inpatient formulary, improving medication use.