Factors Associated With the Prophylactic Prescription of a Bowel Regimen to Prevent Opioid-Induced Constipation.
Identify factors associated with the prophylactic prescription of a bowel regimen with an inpatient opioid prescription.



This was a retrospective cohort study from June 1, 2013, to October 31, 2014 of pediatric inpatients prescribed an oral or intravenous opioid on the general medical/surgical floors. We identified patients with or without a prophylactic prescription of a bowel regimen. We obtained patient demographics, prescriber training level and service and used multivariate logistic regression to analyze the factors associated with prophylactic bowel regimen and opioid prescription.



Of the 6682 encounters that met study criteria, only 966 (14.5%) encounters had prophylactic prescriptions. Patient factors associated with prophylactic prescription include increasing age (per year; odds ratio [OR] = 1.06, 95% confidence interval [CI] 1.05-1.07) and sickle cell diagnosis (OR = 3.19, 95% CI 2.08-4.91). Medication factors associated with prophylactic prescription include a scheduled opioid prescription (OR = 1.75, 95% CI 1.46-2.1) and a prescription for oxycodone (OR = 3.59, 95% CI 2.57-5.00) or morphine (OR = 1.84, 95% CI 1.39-2.44), compared with acetaminophen-hydrocodone. Compared with medical providers, surgeons were less likely (OR = 0.43, 95% CI 0.35-0.53) and pain service providers were more likely to prescribe a prophylactic bowel regimen (OR = 4.12, 95% CI 3.13-5.43).



More than 85% of inpatient opioid prescriptions did not receive a prophylactic bowel regimen. Future research should examine factors (eg, clinical decision support tools) to increase prophylactic prescription of bowel regimens with opioids for populations found to have lower rates.
Division of Hospital Medicine, Phoenix Children's Hospital, Phoenix, Arizona; nchen1@phoenixchildrens.com.
Nancy Y
NY
Chen
Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California; and.
Eugene
E
Nguyen
Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California; and.
Sheree M
SM
Schrager
Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California; and.|Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.
Christopher J
CJ
Russell
D000293:Adolescent; D000367:Age Factors; D000701:Analgesics, Opioid / Q000009:adverse effects*; D000755:Anemia, Sickle Cell / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003248:Constipation / Q000139:chemically induced / Q000517:prevention & control*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005180:Faculty, Medical; D005260:Female; D006760:Hospitalization; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use*; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D009722:Nurse Practitioners; D012189:Retrospective Studies
D000701:Analgesics, Opioid; D054368:Laxatives