WASTE REDUCTION AT A TERTIARY ACADEMIC MEDICAL CENTER: OUR COLACE CRUSADE
Adam Lucy*, Mary G. Cox, Shelby Bergstresser, Jarrett Wright, Elise Dasinger, Kirk Russ, Abhishek Parmar
Surgery, UAB, Birmingham, AL
Background: Reducing anecdotal and wasteful practices is essential to effective patient care. Docusate is an example of a medication that, while lacking efficacy in relieving constipation, is still widely prescribed as first-line therapy. Though docusate is a harmless medication, the potential for cost-saving, time to effective therapy and polypharmacy reduction are significant. The aims of this study were to define laxative prescription practices in an effort to deprescribe docusate and replace it with a stepwise, evidence-based approach to constipation treatment in the adult inpatient.
Methods: We conducted a retrospective study of all adult inpatients at our tertiary care academic medical center. We queried the electronic medical record for prescription patterns for docusate, senna, bisacodyl and polyethylene glycol (PEG) and stratified by prescribing service, unit, administration rate and order set utilization. Medication cost was provided by pharmacy informatics. Docusate deprescribing initiatives were targeted at top prescribing services and units. Information Technology analysts then removed docusate from all inpatient order sets. A new evidenced-based order set with a stepwise approach to constipation was implemented.
Results: From July 2018 to September 2021 all adult inpatient admissions at our institution were queried for laxative prescriptions. For 92,721 total patients, 855,450 docusate prescriptions were ordered from 141 order sets across 75 hospital service lines on 68 different units. Top docusate prescribing services were Trauma (12.5%), Obstetrics (11.6%) and Hospital Medicine (9.2%). Lowest prescribing services included Internal Medicine (0.10%), Palliative Care (0.14%) and Gastroenterology (0.15%). Total average cost was $64,000. Docusate administration rates were 76.9% compared to senna (75.5%), PEG (64.4%) and bisacodyl (22.4%). Estimated total docusate administration time is 15 minutes. This translates to 65,803 annual nursing hours totally over $1.7million in pay spent on docusate administration annually.
Conclusion: The efficacy of docusate as a stool softener has been disproven by rigorous scientific data, yet it is still extensively prescribed over other agents. Outlining current prescribing practices are essential to targeted re-education and meaningful de-prescribing initiatives that can have significant implications for nursing care utilization and hospital costs. We used these data to institute specific quality improvement measures including de-prescribing initiatives to the top prescribing services and units, removal of docusate from all inpatient order sets, and replacing it with a new evidenced-based order set with a stepwise approach to constipation.
Keywords: Constipation; deprescribing; docusate; inpatients; polypharmacy; efficiency; value
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