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Missed opportunity to deprescribe: docusate for constipation in medical inpatients.
Am J Med. 2016 May 3;
Authors: MacMillan TE, Kamali R, Cavalcanti RB
Abstract
BACKGROUND: Hospital admissions provide an opportunity to deprescribe ineffective medications and reduce pill burden. Docusate sodium is a stool softener that is frequently prescribed to treat constipation despite poor evidence for efficacy, thus providing a good target for deprescription. The aims of this study were to characterize rates of use and discontinuation of docusate among internal medicine inpatients, as well as use of other laxatives.
METHODS: We conducted a retrospective observational study over 1 year on all patients admitted to internal medicine at 2 urban academic hospitals to determine rates of docusate use. We also evaluated laxative and opioid medication use on a random sample of 500 inpatients who received docusate, to characterize patterns of prescription and deprescription.
RESULTS: Fifteen percent (1169/7581) of all admitted patients received one or more doses of docusate. Among our random sample, 53% (238/452) received docusate prior to admission, and only 13% (31/238) had docusate deprescribed. Among patients not receiving docusate before admission, 33.2% (71/214) received a new prescription for docusate upon discharge. Patients receiving opioids were frequently prescribed no laxatives or given docusate monotherapy (28%, 51/185).
CONCLUSION: Docusate was frequently prescribed to medical inpatients despite its known ineffectiveness, with low deprescription and high numbers of new prescriptions. Docusate use was common even among patients at high risk of constipation. One-third of patients not receiving docusate prior to admission were prescribed docusate upon discharge, potentially exacerbating polypharmacy. Among patients already receiving docusate, 80% had it continued upon discharge, indicating significant missed opportunities for deprescribing. Given the availability of effective alternatives, our results suggest quality improvement initiatives are needed to promote evidence-based laxative use in hospitalized patients.
PMID: 27154771 [PubMed - as supplied by publisher]