title: Eliminating analgesic meperidine use with a supported formulary restriction.
abstract: OBJECTIVE
  Meperidine is a commonly used analgesic despite unique disadvantages compared with other opioid analgesics. The objective of this study was to measure the effects of a meperidine formulary restriction on the prescribing of parenteral opioid analgesics.
  
  
  METHODS
  The study was performed at a single 750-bed tertiary care teaching hospital in Rochester, NY. The formulary restriction limited meperidine to use exclusively for rigors or procedural sedation and was supported by an educational initiative and a computerized order entry system. Independent computerized pharmacy records were used to capture all doses of parenteral morphine, meperidine, and hydromorphone administered to patients in the emergency department or on a medical or surgical inpatient floor during data-collection periods. Baseline data were collected during two 3-day periods before the formulary restriction; then comparison data were collected during three 3-day periods over 15 months after the formulary restriction.
  
  
  RESULTS
  The number of administered doses of meperidine per day decreased from 37.5 (20.8% of parenteral opioid doses before the restriction) to 0.22 (0.1% of parenteral opioid doses, P = .001). The total number of opioid doses and morphine doses given did not change, whereas the number of hydromorphone doses increased significantly postrestriction, from 16.0 doses per day (8.9% of total) to 59.7 doses per day (29.5%) (P = .009).
  
  
  CONCLUSIONS
  Meperidine formulary restriction, supported by an educational program and computerized order entry, effectively eliminated analgesic meperidine use. Hydromorphone use increased proportionately to offset the decreased use of meperidine.
authors.affiliation: University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. alec_oconnor@urmc.rochester.edu
authors.forename: Alec B
authors.initials: AB
authors.lastname: O'Connor
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Lang
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Quill
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D016303:Clinical Pharmacy Information Systems; D004346:Drug Information Services; D004363:Drug Utilization / Q000639:trends*; D005572:Formularies, Hospital as Topic; D006784:Hospitals, Teaching; D006801:Humans; D004091:Hydromorphone / Q000627:therapeutic use; D007263:Infusions, Parenteral; D008614:Meperidine / Q000627:therapeutic use*; D009020:Morphine / Q000627:therapeutic use; D009518:New York
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D008614:Meperidine; D004091:Hydromorphone