Affiliation:
1. Division of Hospital Medicine, Phoenix Children’s Hospital, Phoenix, Arizona;
2. Division of Hospital Medicine, Children’s Hospital Los Angeles, Los Angeles, California; and
3. Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
Abstract
OBJECTIVE:
Identify factors associated with the prophylactic prescription of a bowel regimen with an inpatient opioid prescription.
METHODS:
This was a retrospective cohort study from June 1, 2013, to October 31, 2014 of pediatric inpatients prescribed an oral or intravenous opioid on the general medical/surgical floors. We identified patients with or without a prophylactic prescription of a bowel regimen. We obtained patient demographics, prescriber training level and service and used multivariate logistic regression to analyze the factors associated with prophylactic bowel regimen and opioid prescription.
RESULTS:
Of the 6682 encounters that met study criteria, only 966 (14.5%) encounters had prophylactic prescriptions. Patient factors associated with prophylactic prescription include increasing age (per year; odds ratio [OR] = 1.06, 95% confidence interval [CI] 1.05–1.07) and sickle cell diagnosis (OR = 3.19, 95% CI 2.08–4.91). Medication factors associated with prophylactic prescription include a scheduled opioid prescription (OR = 1.75, 95% CI 1.46–2.1) and a prescription for oxycodone (OR = 3.59, 95% CI 2.57–5.00) or morphine (OR = 1.84, 95% CI 1.39–2.44), compared with acetaminophen-hydrocodone. Compared with medical providers, surgeons were less likely (OR = 0.43, 95% CI 0.35–0.53) and pain service providers were more likely to prescribe a prophylactic bowel regimen (OR = 4.12, 95% CI 3.13–5.43).
CONCLUSIONS:
More than 85% of inpatient opioid prescriptions did not receive a prophylactic bowel regimen. Future research should examine factors (eg, clinical decision support tools) to increase prophylactic prescription of bowel regimens with opioids for populations found to have lower rates.
Publisher
American Academy of Pediatrics (AAP)
Subject
Pediatrics,General Medicine,Pediatrics, Perinatology and Child Health
Cited by
6 articles.
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