SHM Converge Scientific Abstract ePoster Gallery-Cancel Colace: A Quality Improvement Approach to Reducing Colace Usage

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This quality improvement study examined whether removing docusate from hospital admission order sets would reduce its use and encourage more evidence-based constipation treatments. Docusate is commonly prescribed for inpatient constipation, but prior evidence suggests it has limited benefit, potentially increasing pill burden, cost, and delays in effective treatment.<br /><br />At Jefferson Health, docusate was removed from 500 admission order sets across 12 hospitals on April 4, 2023, and replaced with more evidence-based bowel regimens such as polyethylene glycol (PEG) and senna. Researchers compared inpatient medication administration during the 180 days before and after the intervention, reviewing docusate, bisacodyl, senna, PEG, methylnaltrexone, enemas, and suppositories. They also analyzed medication pricing to estimate cost impact.<br /><br />Results showed that docusate administration fell substantially, from 140,619 doses pre-intervention to 75,180 post-intervention, a 53% decrease, which was statistically significant (p < 0.0001). This translated to an estimated reduction of 132,696 doses per year. Use of some alternative bowel medications increased, including PEG, senna, bisacodyl, and methylnaltrexone. Estimated medication cost savings from reduced docusate use were $7,500.39 per year, not including pharmacy or nursing time.<br /><br />The authors concluded that removing docusate from order sets significantly reduced its administration and increased use of more evidence-based bowel regimens. They noted that the 180-day observation periods may not fully capture longer-term prescribing trends and that further study is needed to understand the net annual cost effects. Overall, the project suggests that limiting access to low-value medications can improve prescribing practices.

Asset Subtitle

Elizabeth Klingensmith

Meta Tag

Author List Alan A. Kubey, Dana M. Jordan, Elizabeth Klingensmith, Jeffrey M. Riggio

Category Research

Concept Docusate

Concept Evidence-Based Bowel Regimen

Concept Quality Improvement Intervention

Concept Medication Burden

Concept Admission Order Set

Distinguished Non-Finalist

Presenter Organization Sidney Kimmel Medical College

Presenting Author Elizabeth Klingensmith

Track Quality Improvement

Keywords

docusate

constipation

hospital order sets

quality improvement

evidence-based treatment

polyethylene glycol

senna

inpatient medication use

bowel regimen

cost savings

Docusate

Evidence-Based Bowel Regimen

Quality Improvement Intervention

Medication Burden

Admission Order Set