title: Efficacy and safety of scheduled dosing of opioid analgesics: a quality improvement study.
abstract: Scheduled dosing of opioids is believed to provide more effective analgesia when compared to as needed (PRN) administration of the drug; however, few studies have evaluated the value of this approach. Therefore, a quality improvement study was conducted to determine the efficacy and safety of scheduled dosing of opioid analgesics, using a 2-group parallel design. One medical unit in a large urban academic medical center employed scheduled dosing, whereas a comparable unit used PRN dosing. The primary outcome indicators included pain intensity ratings and opioid doses, along with adverse events. Scheduled dosing was associated with decreased pain intensity ratings. There were no statistically significant differences in the amount of opioid ordered, or the amount administered when comparing scheduled vs. PRN dosing. However, when the amount of opioid given was expressed as a percentage of the amount ordered, the difference between scheduled (70.8%) and PRN (38%) dosing was statistically significant (P = .0001). There was no difference in adverse events between the 2 groups. These findings suggest that scheduled dosing of opioids in an inpatient medical population provides improved analgesia with no increased risk of adverse events.
  
  
  CONCLUSIONS
  Scheduled dosing of opioids in an inpatient medical population improves analgesia, theoretically by overcoming barriers to drug administration, as well as providing more stable plasma levels of the opioid.
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA. j-paice@northwestern.edu
authors.forename: Judith A
authors.initials: JA
authors.lastname: Paice
authors.forename: Gary A
authors.initials: GA
authors.lastname: Noskin
authors.forename: Arvydas
authors.initials: A
authors.lastname: Vanagunas
authors.forename: Susan
authors.initials: S
authors.lastname: Shott
mesh_terms: D000046:Academic Medical Centers / Q000592:standards; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010146:Pain / Q000188:drug therapy* / Q000523:psychology*; D018710:Pain Clinics / Q000592:standards; D010147:Pain Measurement; D017288:Pain Threshold / Q000187:drug effects; D017060:Patient Satisfaction; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid