Improving Patient Safety: Decreasing NSAID Adverse Effects by Educating Providers About Appropriate NSAID Prescribing Practices

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most widely used analgesics prescribed by primary care providers (Brattwall, Turan, & Jackobson, 2010). Use of NSAIDs increase patient risk for cardiovascular events and gastrointestinal bleeding. These risks are increased with higher doses and longer course durations (Bally et al., 2017). Providers often prescribe NSAIDs at higher doses and for longer durations than actually necessary (Jain et al., 2015). Purpose: To improve patient safety by educating primary care providers about the adverse effects associated with NSAIDs, analgesic ceiling of NSAIDs, and the importance of prescribing the lowest effective dose for the shortest duration in the adult and young adult population at four small urban health care clinics. Methods: This quality improvement project was implemented at four small urban healthcare facilities located in the Salt Lake City area (N=20). The study design consisted of a pre-post-test where baseline data was collected prior to implementation of the NSAID educational training, immediately after, and approximately four weeks after the intervention. Measures: The effectiveness of the intervention was evaluated by using change statistics from the pre- and post-surveys. The educational training was deemed successful if providers showed a change in their knowledge and or NSAID prescribing practices after training. Results: Twenty providers participated in the pre-survey, 16 (80%) in the educational training and post-survey, and a total of 13 (65%) who completed the entire project. There was a statistically significant increase in providers' knowledge about adverse effects of NSAIDs (4.94 + 0.25) as well as analgesic ceiling doses of ibuprofen (4.81 + 0.75) and ketorolac (4.80 + 0.77) from pre- to post-survey. Four weeks after the initial educational intervention, 92% (12) of providers reported the training as impacting their prescribing practices as either very positively or positively (4.5 + 0.58). Conclusions: The implementation of an NSAID Educational Training is feasible in small urban healthcare facilities. Results of this study provide preliminary evidence that prescribing providers can improve their NSAID prescribing practices by education on the recommended dosages and side effects.