Abstract
BackgroundAs-needed (PRN) opioid orders with duplicate indications can lead to medication errors and opioid-related adverse drug events.ObjectiveThe objective of our study was to build and validate real-time alerts that detect duplicate PRN opioid orders and assist clinicians in optimizing the safety of opioid orders.MethodsThis single-center, prospective study used an iterative, 3-step process to refine alert performance by advancing from small sample evaluations of positive predictive values (PPVs) (step 1) through intensive evaluations of accuracy (step 2) to evaluations of clinical impact (step 3). Validation cohorts were randomly sampled from eligible patients for each step.ResultsDuring step 1, the PPV was 100% (one-sided, 97.5% CI 70%-100%) for moderate and severe pain alerts. During step 2, duplication of 1 or more PRN opioid orders was identified for 17% (34/201; 95% CI, 12%-23%) of patients during chart review. This bundle of alerts showed 94% sensitivity (95% CI 80%-99%) and 96% specificity (95% CI 92%-98%) for identifying patients who had duplicate PRN opioid orders. During step 3, at least 1 intervention was made to the medication profile for 77% (46/60; 95% CI 64%-87%) of patients, and at least 1 inappropriate duplicate PRN opioid order was discontinued for 53% (32/60; 95% CI 40%-66%) of patients.ConclusionsThe bundle of alerts developed in this study was validated against chart review by a pharmacist and identified patients who benefited from medication safety interventions to optimize PRN opioid orders.
Highlights
Duplicate as-needed (PRN) opioid orders that are indicated for the same pain level can lead to medication errors, opioid-related adverse drug events, and confusion among bedside nurses
On September 18, 2018, 2 implicit alerts were added to the bundle to identify duplication between orders with unclear PRN indications (“breakthrough pain” or “any pain”) and any other PRN opioid order
This study evaluated the accuracy, validity, and clinical impact of a set of real-time alerts to identify and address duplicate PRN opioid orders
Summary
Duplicate as-needed (PRN) opioid orders that are indicated for the same pain level can lead to medication errors, opioid-related adverse drug events, and confusion among bedside nurses. 1 (page number not for citation purposes) triggering drug-drug interactions or best practice alerts based on the PRN indication field specified in medication orders [6]. The purpose of this project was to build and validate real-time alerts within a third-party pharmacovigilance software that detect PRN opioid orders with a duplicate pain indication and provide clinicians with a clinically impactful tool to optimize the safety of PRN opioid orders in the hospital EHR. As-needed (PRN) opioid orders with duplicate indications can lead to medication errors and opioid-related adverse drug events
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