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Evaluating the effects of a revised standard admission order set on laxative prescribing practices for opioid induced constipation
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Pandey, Shila. Evaluating the effects of a revised standard admission order set on laxative prescribing practices for opioid induced constipation. Retrieved from https://doi.org/doi:10.7282/t3-jvfd-nx07

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TitleEvaluating the effects of a revised standard admission order set on laxative prescribing practices for opioid induced constipation
NamePandey, Shila (author); Vitale, Tracy (chair); Haviland, Kelly (member); Goldberg, Jessica I. (member); Rutgers University; RBHS School of Nursing
Date Created2021-10-29
Other Date2022-01 (degree)
SubjectNursing, Cancer, Docusate, Laxatives, Opioid induced constipation, Pain, Quality improvement
Extent153 pages : illustrations
DescriptionPurpose of Project: Opioid-induced constipation is highly prevalent in patients with cancer pain on opioid analgesics and has negative consequences on physical and psychological wellbeing and quality of life. Oncology clinical practice guidelines recommend the use of osmotic and stimulant laxatives for the prevention and management of opioid induced constipation, not stool softeners such as docusate sodium. Prescribing practices continue to fall behind these recommendations. This quality improvement project aimed to improve laxative prescribing for the prevention and management of opioid induced constipation in hospitalized adults with cancer.
Methodology: This quality improvement project used the electronic health record to revise the laxative options available in the standard admission order set. Specifically, docusate sodium was removed and replaced with senna and polyethylene glycol 3350. Hospital prescribers were surveyed on laxative prescribing knowledge and preference before and after the intervention.
Results: A total of 2742 patient admissions preintervention were compared to 2752 admissions postintervention. The number of orders for docusate (p < 0.001) and docusate-senna (p = 0.002) orders decreased significantly after the intervention. However, the number of orders for polyethylene glycol (p = 0.559), senna (p = 0.582), other laxatives (p = 0.245), or functional bowel disorder medications (p = 0.533) did not change significantly. The number of patients with a diagnosis of opioid induced constipation decreased significantly, p < 0.001. No significant differences were observed in the frequency of laxative orders placed within 24 hours of an opioid order, number of laxatives prescribed at discharge, admissions related to bowel related complications, or length of stay. Survey responses were insufficient to determine and change in prescribing practice.
Implications for Practice: Prompt use of osmotic and stimulant laxatives with initiation of opioids can prevent burdens of opioid induced constipation. Interventions utilizing the electronic health record can facilitate evidence-based management of opioid induced constipation. Tailoring these interventions further has the potential of cost savings, a reduction of nursing hours spent on administering docusate, reduced hospital length of stay, and reduced health care utilization related to constipation. Development of a clinical practice guideline for the prevention and management of opioid induced constipation is needed to reinforce prescribing practices.
NoteD.N.P.
NoteIncludes bibliographical references
Genretheses
Persistent URLhttps://doi.org/doi:10.7282/t3-jvfd-nx07
LanguageEnglish
CollectionSchool of Nursing (RBHS) DNP Projects
Organization NameRutgers, The State University of New Jersey
RightsThe author owns the copyright to this work.
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