Eliminating analgesic meperidine use with a supported formulary restriction.
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.
O'Connor
Alec B
AB
University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. alec_oconnor@urmc.rochester.edu
Lang
Valerie J
VJ
Quill
Timothy E
TE
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
D000701:Analgesics, Opioid; D009020:Morphine; D008614:Meperidine; D004091:Hydromorphone