Analgesic Prescribing Practices Can Be Improved by Low-Cost Point-of-Care Decision Support

Abstract Context Codeine has become a controversial choice for analgesia in children compared with other commonly available drugs. Objectives To evaluate whether an educational campaign shifted resident prescribing patterns away from codeine toward more appropriate analgesics. Methods Our intervention consisted of a pocket-sized reference card given to all trainees and key staff in an inpatient pediatric acute care unit; pediatrics residents also had the option to attend a one-hour lecture. The pocket card recommended against codeine (including rationale) and gave prescription guidance for our institution's preferred formulary alternative analgesics, which include tramadol and hydrocodone. We used inpatient prescribing data to track the prescribing of codeine and alternative medications over time. Results Following the interventions, there was a significant decrease in the percentage of patients receiving codeine (13.5% of patients received the drug in the year before, 5.4% in the year after, P < 0.0001). Use of hydrocodone-containing analgesics increased overall during the same period (7.4%–16%, P