Getting Ahead of What's Behind: EMR Enhancements Targeting Opioid-Induced Constipation

Outcomes 1. Implement EMR enhancements prompting inpatient providers to consider scheduling bowel care when ordering scheduled opioids for admitted cancer patients on chronic opioid therapy.2. Track changes in use of opioid-constipation reversal medications and constipation-induced complications.Key MessageIn cancer patients on chronic opioid therapy, those with constipation have substantially higher total healthcare costs. This QI brings a prophylactic focus to opioid-induced constipation in opioid-prescribed patients in the inpatient setting via electronic medical record (EMR) enhancements.Abstract: Introduction/Context: Opioid-induced constipation can significantly impair patient quality of life and satisfaction, with patients experiencing substantial burdens in mental health, activities of daily living, and incurring high health care costs with a subsequent economic burden (Argoff 2020).For patients treated with strong opioids over a six-month period, total costs per patient month increased with increasing degree of constipation (Hjalte 2010). Specifically in cancer patients on chronic opioid therapy, those with constipation had substantially higher total healthcare costs, including greater utilization of inpatient services, emergency evaluation, clinic office visits, and nursing home care (Candrilli 2009).Focusing on opioid-induced constipation has shown to decrease odds of hospitalization and re-encounters in the emergency department (Peacock 2022).Objectives1.Implement EMR enhancements prompting inpatient providers to consider scheduling bowel care when ordering scheduled opioids for admitted cancer patients on chronic opioid therapy. 2. Track changes in use of opioid-constipation reversal medications and constipation-induced complications.MethodsProposed EMR enhancements include: adding a bowel care sub-tab to existing pain management ordering plans, an EMR alert suggesting bowel care medication at time of ordering scheduled opioids, an EMR alert suggesting bowel care medication if no bowel care is scheduled within 24 hours after a scheduled opioid is ordered.Compare pre- and post-EMR enhancement incidence of the following in admitted cancer patients on scheduled opioid therapy with known chronic opioid therapy: inpatient use of methylnaltrexone and naloxegol, incidence of opioid-induced constipation complications (including ICD-10 code denoting stercoral colitis, fecal impaction, bowel perforation), and hospital LOS.ResultsPending upon roll out of EMR enhancements.KeywordsQuality Improvement; Management of Medical Interventions 1. Implement EMR enhancements prompting inpatient providers to consider scheduling bowel care when ordering scheduled opioids for admitted cancer patients on chronic opioid therapy. 2. Track changes in use of opioid-constipation reversal medications and constipation-induced complications. In cancer patients on chronic opioid therapy, those with constipation have substantially higher total healthcare costs. This QI brings a prophylactic focus to opioid-induced constipation in opioid-prescribed patients in the inpatient setting via electronic medical record (EMR) enhancements.Abstract: Introduction/Context: Opioid-induced constipation can significantly impair patient quality of life and satisfaction, with patients experiencing substantial burdens in mental health, activities of daily living, and incurring high health care costs with a subsequent economic burden (Argoff 2020). For patients treated with strong opioids over a six-month period, total costs per patient month increased with increasing degree of constipation (Hjalte 2010). Specifically in cancer patients on chronic opioid therapy, those with constipation had substantially higher total healthcare costs, including greater utilization of inpatient services, emergency evaluation, clinic office visits, and nursing home care (Candrilli 2009). Focusing on opioid-induced constipation has shown to decrease odds of hospitalization and re-encounters in the emergency department (Peacock 2022). 1.Implement EMR enhancements prompting inpatient providers to consider scheduling bowel care when ordering scheduled opioids for admitted cancer patients on chronic opioid therapy. 2. Track changes in use of opioid-constipation reversal medications and constipation-induced complications. Proposed EMR enhancements include: adding a bowel care sub-tab to existing pain management ordering plans, an EMR alert suggesting bowel care medication at time of ordering scheduled opioids, an EMR alert suggesting bowel care medication if no bowel care is scheduled within 24 hours after a scheduled opioid is ordered. Compare pre- and post-EMR enhancement incidence of the following in admitted cancer patients on scheduled opioid therapy with known chronic opioid therapy: inpatient use of methylnaltrexone and naloxegol, incidence of opioid-induced constipation complications (including ICD-10 code denoting stercoral colitis, fecal impaction, bowel perforation), and hospital LOS. Pending upon roll out of EMR enhancements. Quality Improvement; Management of Medical Interventions References: Argoff, Charles. "Opioid-induced Constipation: A Review of Health-related Quality of Life, Patient Burden, Practical Clinical Considerations, and the Impact of Peripherally Acting u-Opioid Receptor Antagonists." Clin J Pain. 2020 Sep; 36(9): 716-722. Published online 2020 Jun 16. Hjalte, Frida et al. "The Direct and Indirect Costs of Opioid-Induced Constipation." J Pain Symptom Manage. 2010 Nov; 40(5): 696-703. Published online 2010 Aug 21. Candrilli, Sean et al. "Impact of Constipation on Opioid Use Patterns, Health Care Resource Utilization, and Costs in Cancer Patients on Opioid Therapy." J Pain Palliat Care Pharmacother. 2009; 23(3):231-241. Peacock, W Frank et al. "Opioid-Induced Constipation: Cost Impact of Approved Medications in the Emergency Department." Adv Ther. 2022 May; 39(5): 2178-2191. Published online 2022 Mar 17.