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J Pain Symptom Manage. 2011 Oct;42(4):623-31. doi: 10.1016/j.jpainsymman.2011.01.008. Epub 2011 Mar 31.

Analgesic prescribing practices can be improved by low-cost point-of-care decision support.

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Division of Pediatric Hospital Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA.



Codeine has become a controversial choice for analgesia in children compared with other commonly available drugs.


To evaluate whether an educational campaign shifted resident prescribing patterns away from codeine toward more appropriate analgesics.


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.


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 < 0.0001) as did tramadol use (0.2%-2.6%, P < 0.0001). There were no changes in pain management satisfaction scores.


A simple low-cost educational campaign consisting primarily of a pocket guide to analgesics markedly improved analgesic prescribing patterns, and that improvement extended to services not targeted by the didactic component of our educational campaign. Point-of-care decision support by means of a pocket card may be sufficient for effecting change in medication prescribing patterns of trainees.

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