Background Despite the increased use of electronic medical records (EMRs) in past years, the recording of clinically useful baseline pain information may still be lacking. An educational effort targeted at the acute pain service and reinforced by electronic prompting may be an effective way to promote electronic documentation of relevant pain metrics. The objective of this study was to assess whether an educational effort with electronic prompting in the EMR promotes the documentation of baseline pain scores and preoperative opioid use by an acute pain service (APS). Methods A total of 98 patients were included in this study: 49 in the study group and 49 in the control group. The study group consisted of patients who underwent knee and hip arthroplasties after the institution of a multimodal analgesia educational program that also incorporated an electronic prompt to promote behavior change. Primary outcomes were the frequency of documentation of baseline pain scores and preoperative opioid use. Results After the implementation of the education initiative, 67% of the patients had baseline pain scores recorded in the preoperative APS documentation, compared to 20% in the control group ( p = 0.0001). Preoperative opioid use was recorded in 24% of APS documentation within the control group, but this increased to 73% after the educational intervention ( p = 0.0001). Documentation of resting pain scores on the day of surgery also increased from 59% to 87% ( p = 0.0014). Conclusions The introduction of a multi-dimensional educational effort focused on baseline pain metric recording within the context of an analgesic change of practice increased assessment of both baseline pain and preoperative opioid use by APS. These results can be applied to other settings in which a focused change of practice is required and an electronic medical record already utilized.

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We read with interest the article, "Initial Case Report of Cladorrhinum samala Mycotic Keratitis" in the publish ahead of print section of the Cornea journal about the identification of a new member in the Cladorrhinum family. 1 However, the article mentions that only 2 human cases of keratitis due to the previously known species, Cladorrhinum bulbillosum, are alluded to in the literature. We wish to point out that we have reported a series of 4 patients with infective keratitis due to this rare dematiaceous fungus in an indexed publication. 2 They had presented with variably pigmented corneal infiltrates. After corneal scraping, 2 were identified based on morphology in culture which showed typical microsclerotia. The other 2 were confirmed with polymerase chain reaction (PCR) DNA sequencing. All patients had an indolent and prolonged clinical course on topical antifungals but eventually resolved on medical management.