务实的紧急情况部门干预 减少默认 处方的阿片类药片数量
Drake Gotham Johnson1, Alice Y Lu1, Georgia A Kirn1
1University of California San Francisco, Department of Emergency Medicine, San Francisco, California.
The western journal of emergency medicine
|July 19, 2024
概括
减少电子健康记录 (EHR) 默认的阿片类药物量在急诊室 (ED) 显著减少了阿片类药物处方. 这种质量改善干预措施降低了每次出院的阿片类药片数量,但没有影响患者人口统计.
科学领域:
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
- 临床信息学 临床信息学
背景情况:
- 阿片类药物流行仍然是美国的关键公共卫生问题,急诊部 (ED) 的阿片类药物处方有助于阿片类药物使用障碍.
- 以前的研究表明,ED阿片类药物处方和阿片类药物使用障碍的发生率之间存在剂量依赖的关系.
- 电子健康记录 (EHR) 默认设置的系统性更改可以影响处方实践.
研究的目的:
- 评估质量改善干预措施的影响,包括降低EHR默认阿片类药物数量.
- 评估这项干预措施对大规模,学术,城市,高等保健ED的阿片类药物处方实践的影响.
- 检查临床医生类型 (医生,医生助理,护士) 和患者人口统计学方面的潜在差异性影响.
主要方法:
- 收集了2019年1月至2021年12月所有ED出院的阿片类药物处方的EHR数据.
- 实施了2021年3月29日宣布的通常处方阿片类药物的EHR默认处方量从20片降低到12片.
- 干预前后测量每次出院的阿片类药片数量,患者人口统计数据和临床间处方变化.
主要成果:
- 每次出院的阿片类药物药片数量减少了14% (从14片降至12片;P<.001).
- 根据患者的种族或性别,没有发现处方的统计学上显著差异.
- 执业护士和医生助理,他们平均开出更多的阿片类药物,干预后的处方显著下降,医生也是如此.
结论:
- 降低EHR默认数量是减少ED中阿片类药物处方的有效和简单策略.
- 这种干预具有广泛实施的潜力,特别是在EDs中,默认数量超过建议限制.
- 未来的干预措施应考虑将EHR默认更改与针对不同临床医生群体的有针对性的策略相结合,以进一步优化阿片类药物处方减少.
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