Medical and Nursing Staff Education Reduces Use of Prophylactic Ondansetron With Opioids in the Emergency Department.

Introduction: We aimed to evaluate the effect of a pharmacist-led educational intervention on administration of ondansetron in patients receiving IV opioid analgesia in the emergency department.

Methods: This study is a retrospective chart review undertaken in a single-community emergency department. During October and November 2015, emergency medicine pharmacists completed an educational initiative targeting medical and nursing staff designed to reduce prophylactic administration of ondansetron. The multifaceted educational initiative comprised of a link to an animated video, posters at strategic locations in the department, e-mail reminders, brief presentations during shift change, and 1-on-1 discussion (see https://www.youtube.com/watch?v=Uvx8zKJBCCI). All patients who received IV morphine or hydromorphone during September and December 2015 were identified using pharmacy dispensing records, and 150 patients from each period were randomly selected for retrospective chart review. The primary outcome was the change in the proportion of prophylactic administration of ondansetron with IV opioids for acute pain in the emergency department.

Results: The proportion of patients administered prophylactic ondansetron decreased from 41% in the preintervention period to 26% in the postintervention period (difference 95% confidence interval [CI] 4.8 to 25.9, P = 0.005). Therapeutic use for documented nausea or vomiting upon presentation decreased marginally from 44% to 35% (difference 95% CI -2.3 to 19.7, P = 0.1). An overall decrease in the incidence of administration of ondansetron from 85% to 61% was observed (difference 95% CI 14.4 to 33.6, P < 0.001). No patient required rescue antiemetic administration.

Conclusions: Medical and nursing staff education yielded a significant reduction in the administration of prophylactic ondansetron for patients receiving IV opioids in the emergency department.