Association of Dissemination of an Educational Communication Tool With Docusate Administration

Abstract

IMPORTANCE A clear message and call to action can affect the use of a medication with limited efficacy.OBJECTIVES To assess the association of the dissemination of an educational document about the lack of efficacy of docusate with docusate administration and whether changing docusate administration was associated with a change in administration of comparable laxatives. DESIGN, SETTING, AND PARTICIPANTSIn this quasi-experimental, pre-post study of all acute care and continuing care facilities serviced by Alberta Health Services in Alberta, Canada, an interrupted time series analysis was performed to examine the association of an educational communication tool with docusate administration from June 1, 2014, through May 31, 2016.INTERVENTIONS A Drugs & Therapeutics Backgrounder was disseminated to all pharmacists in December 2014. Backgrounders are academic detailing tools to assist pharmacists in supporting drug stewardship and are supplemented by online, interactive webinars. MAIN OUTCOMES AND MEASURESThis study examined whether a decrease in docusate administration across the organization occurred after release of the backgrounder. Messaging in the backgrounder stated that, unless clinically necessary, docusate should not be replaced by another medication. This study assessed whether that message was accepted by measuring administration of comparable laxatives. Study medication administration is reported as defined daily doses (DDDs) per 1000 inpatient-days (PDs). Rates were compared for the 6 months before the intervention and 3, 6, 12, and 18 months after intervention. RESULTS Among the 111 acute care facilities (8500 beds) and 24 000 long-term care beds of the Alberta Health Services, predicted docusate administration decreased from preintervention (474 DDDs/1000 PDs) to 3 months (321 DDDs/

A Quality Improvement Approach to Decrease the Utilization of Docusate in Hospitalized Patients

“…Following publication and dissemination of literature on the poor efficacy or lack of evidence demonstrating efficacy of docusate, AHS observed a 54.9% decrease in its use after 18 months. 8 In 2018, Rush University Medical Center utilized QI strategies to implement an intervention focused on emailing and providing in-person education to residents and hospitalists about why they should no longer prescribe docusate. They found in their post-intervention analysis that docusate doses per 100 bed days were decreased by a statistically significant value of 39%.…”

“…For example, Alberta Health Services (AHS) in Canada has listed docusate as a nonformulary product and promotes the use of other laxatives supported by high-quality evidence to treat constipation. Following publication and dissemination of literature on the poor efficacy or lack of evidence demonstrating efficacy of docusate, AHS observed a 54.9% decrease in its use after 18 months 8. In 2018, Rush University Medical Center utilized QI strategies to implement an intervention focused on emailing and providing in-person education to residents and hospitalists about why they should no longer prescribe docusate.…”

Enhancing the quality of prescribing practices for older adults discharged from the emergency department in Rhode Island

“…First‐generation antipsychotics, like haloperidol, have high rates of extrapyramidal side effects such as acute dystonia and tardive dyskinesia due to dopamine receptor blockade, and should be avoided in Parkinson's disease 27 . Additionally, the stool softener senna with docusate was added because it is safe and more efficacious than docusate alone in geriatric populations 28,29 . Thereafter, the order set was approved and validated by the health system's pharmacy & therapeutics committee.…”

“…27 Additionally, the stool softener senna with docusate was added because it is safe and more efficacious than docusate alone in geriatric populations. 28,29 Thereafter, the order set was approved and validated by the health system's pharmacy & therapeutics committee.…”

The postbiotic of hawthorn-probiotic ameliorating constipation caused by loperamide in elderly mice by regulating intestinal microecology

“…Meanwhile, constipation has a 50% recurrence rate ( 4 ). Constipation increases discomfort and may lead to abdominal cramping and straining on defecation that ultimately affect quality of life ( 5 ). Prolonged constipation can also lead to neurasthenia, metabolic disorders, and even sepsis ( 6 ).…”