132 Failure of Prescribing Bowel Regimens at Hospital Discharge for Patients on Opioid Medications

Abstract

INTRODUCTION: Opioid-induced constipation (OIC) is estimated to affect 40–80% of those on opioid therapy. Aside from added costs to the healthcare system, untreated constipation can cause adverse effects ranging from abdominal pain to more serious complications such as colonic perforation. No specific guidelines exist on the prescription of bowel regimens with opioid medications; however, expert opinion suggests that a bowel regimen should be prescribed with any opioid medication. The objective of this study was to evaluate the frequency of prescribing a bowel regimen with opioid medications on inpatient discharge medication reconciliations. METHODS: We identified all patients at an academic institution admitted on the general medical-surgical floors from the dates of 1/1–1/14/18. The discharge summaries of all patients admitted during the above time period were manually reviewed, and patients who were discharged on an opioid medication were identified. Of those patients, we identified those who were discharged on a bowel regimen and noted the specific regimen at discharge. No distinction was made between a new or prior prescription for opioid medication. We then calculated the percentage of patients who were discharged on an opioid medication with a bowel regimen. RESULTS: 380 patients were admitted from 1/1–1/14/2018 on the general medical-surgical floors. Of those 380 patients, 12 were excluded due to chart restrictions and death during admission. Of the 368 patients remaining, 184 (50%) were male and 184 (50%) were female. 145 (39.4%) were discharged on an opioid. Of that population, only 72 (49.7%) were discharged on a bowel regimen. 116 of 145 were discharged on a single opioid regimen, and of those, 48 (41.4%) were discharged on a bowel regimen. 28 of 145 were discharged on dual opioid regimen, and of those, 23 (82.1%) were discharged on a bowel regimen. CONCLUSION: Despite the clear association of constipation with opioid use, more than half of patients discharged on an opioid medication were not prescribed a bowel regimen. Due to the wide-ranging complications of constipation and its economic burden, clear prescribing guidelines for bowel regimens with opioids need to be established. Within our institution, further research is to be conducted on developing a flagging system within the EMR at discharge to identify patients who are discharged on an opioid medication and to provide recommendation for the appropriate regimen for these patients.