Evaluation of the acceptance rate of analgesic stewardship team recommendations at a metropolitan hospital network
Hatsumi Kobayashi, Jeremy Szmerling, Sam Maleki, Mahisha Thiruvasagan, Gordon MarAbstract
Background
Analgesic stewardship (AGS) programs, a novel concept in Australia, aim to assess and optimise opioid and other analgesia by carrying out medication reviews and providing clinical recommendations to the treating teams.
Aim
This study aimed to determine the rate and extent of acceptance of AGS team recommendations among adult inpatients within a metropolitan hospital network.
Method
This 12‐month retrospective study included patients admitted to an acute hospital within an approximate 1500‐bed hospital network between 1 January–31 December 2023. Patients were included if they had at least one AGS progress note documented during their hospital stay. Quantification of AGS recommendations, evaluation of recommendation outcomes, and comparison of recommendation acceptance against hospital site, medical unit, and patient demographics were conducted. Patients for whom none of the AGS recommendations were accepted were analysed thematically. This project was exempt due to the local policy requirements that constitute research by the Eastern Health Research Ethics Committee (Reference no: QA24‐056‐109 074). The justification for this exemption was as follows: the project only was retrospective, utilised routinely collected data, and Australian National statement on ethical conduct in human research .
Results
A total of 2047 AGS recommendations were identified across 901 patients (median age 78 years, range 18–105, 61% female), with a median of two recommendations per patient (interquartile range 2–3). For 620 patients (69%), all recommendations were implemented. The most common reason for non‐acceptance was recommendations being missed by the treating team. Recommendations made at the largest hospital site by bed number were associated with higher acceptance (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.37–2.73). Acceptance was also higher for surgical units (OR 2.02, 95% CI 1.35–3.01), corresponding to approximately double the odds, than for non‐surgical units. Younger adult patients (aged <65 years) had higher odds of recommendation acceptance than those aged ≥65 years (OR 1.65, 95% CI 1.07–2.55).
Conclusion
AGS recommendation acceptance rate was high, particularly for adult patients (<65 years) admitted under surgical units. Addressing factors associated with non‐acceptance and examining longitudinal trends may further optimise AGS service impact on opioid and analgesia use.