2025 Southeastern Residency Conference

IMPACT OF PATIENT PREFERENCE ON INPATIENT ANALGESIA


Lauren Alaine “Lainey” LaMoyne, MaryAnn Birch, Lisa Scott


HCA Florida West Hospital – Pensacola, FL


Background/Purpose: Non-opioid analgesics are often underutilized as part of a multimodal approach. Additionally, patients may prefer non-opioids for moderate to severe pain, but these agents are often only prescribed for mild pain. In response, several changes were implemented to policy and an analgesic order set, and provider and nursing education was provided. The purpose of this study was to see if a pain management intervention consisting of usage of a standardized order set, new policy, and education will increase the usage of non-opioids administered for pain.


Methodology: This is a single center, quasi-experimental study conducted at a 515-bed academic hospital. Adult acute care inpatients were included if they were ordered a PRN (as needed) opioid pain medication and a non-opioid (acetaminophen or ibuprofen). Patients were identified using facility surveillance software reports. Patients were excluded if they had opioid use disorder, active malignancy, requirements of greater than 60 morphine milliequivalents per day before admission, contraindication or allergy to study drug, intravenous acetaminophen administration, incomplete documentation of pain scale, use of a scheduled opioid, and/or opioid reversal prior to inpatient status. Patients were also excluded if admitted to the labor and delivery unit, the intensive care unit, or palliative care. Cohort 1 consists of patients prescribed both opioids and non-opioids (acetaminophen or ibuprofen) without utilization of the revised opioid order set. Cohort 2 includes patients prescribed medications from the revised opioid order set. The primary outcome is the number of times a non-opioid was given for analgesia. The secondary outcomes are patient-reported pain scores and the number of times a non-opioid was given for moderate to severe pain per patient preference.


Results: One hundred and six patients were included in this study. The primary outcome of number of times a non-opioid was given for analgesia per length of days was 0.71 and 1.27 for cohorts 1 and 2, respectively (p=0.0362). The number of times a non-opioid was given for moderate to severe pain per length of days analyzed was 0.03 in cohort 1 and 0.2 in cohort 2 (p=0.0263). The number of times an opioid was given for moderate to sever pain per length of days analyzed was 1.3 in cohort 1 as compared to 1.3 in cohort 2 (p=0.8630). The mean non-opioid change in pain score was 1.4 in cohort 1 and -2.3 in cohort 2 (p=0.0818). The mean opioid change in pain score was -4.0 for cohort 1 as compared to -3.8 in cohort 2 (p=0.4879).
 
Conclusions: There was a statistically significant increase in the number of times non-opioids were administered for analgesia and a statistically significant increase in scheduled APAP utilization. There was also a statistically significant increase in the number of times opioids were given for breakthrough pain. Opioid administrations for moderate to severe pain did not result in a statistically significant difference, and there was no statistical difference in average daily MME between cohortss. Pain Scores could not be accurately assessed due to small sample size. Future studies with a larger sample size are warranted to further investigate the implications of patient preference.


This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.