Impact of Order Set on Exocrine Pancreatic Insufficiency in Chronic Pancreatitis, Pancreatic Cancer, and Pancreatic Resection
Background and Aims: Enzyme insufficiency (EPI) is common in chronic pancreatitis (CP), pancreatic ductal adenocarcinoma (PDAC), and after pancreatic resection. 40%–50% of CP patients and 70%–80% of PDAC patients develop EPI. 1/3rd of these patients are prescribed Pancreatic enzyme replacement thera...
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Elsevier
2025-01-01
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| Series: | Gastro Hep Advances |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772572324001353 |
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| author | Michael Ladna Ishaan Madhok Adnan Bhat Nicole Ruiz Jackson Brown Jake Wilson Peter Jiang Robert Taylor Mark Radetic John George Christopher Forsmark |
| author_facet | Michael Ladna Ishaan Madhok Adnan Bhat Nicole Ruiz Jackson Brown Jake Wilson Peter Jiang Robert Taylor Mark Radetic John George Christopher Forsmark |
| author_sort | Michael Ladna |
| collection | DOAJ |
| description | Background and Aims: Enzyme insufficiency (EPI) is common in chronic pancreatitis (CP), pancreatic ductal adenocarcinoma (PDAC), and after pancreatic resection. 40%–50% of CP patients and 70%–80% of PDAC patients develop EPI. 1/3rd of these patients are prescribed Pancreatic enzyme replacement therapy (PERT), often at an inadequate dose, with evidence that this leads to increased morbidity and mortality. This study aimed to develop and implement an EPIC-based best practice alert (BPA) and smart set to improve the management of EPI. Methods: A retrospective analysis of all patients with International Classification of Diseases codes for EPI, CP, and PDAC or CPT code for pancreatic resection from Feb-2018 to Feb-2021. Appropriate use of PERT was defined as ≥ 40,000 units of lipase with each meal. The BPA and smart set were implemented into the electronic medical record in Feb-2020. The BPA fired if the patient was already on PERT or if an order for PERT was placed and directed the clinician to the smart set which provided PERT formulations each prefilled to the minimum therapeutic dose of 40,000 units of lipase. Results: A significant increase in the proportion of patients on minimum therapeutic dose of PERT from 61.9% to 72.9% (P ≤ .001). Ordering of pancreatic elastase, A1c, vitamin D, and dual X-ray absorptiometry increased from 20.4% to 29.9% (P < .001), 54.7%–62.1% (P = .001), 30.9%–48.1% (P < .001) and 10%–18% (P < .001), respectively. The BPA triggered a total of 30,838 times resulting in the smart being opened a total of 624 (2.02%) times over 24 months. Conclusion: The BPA and smart set were associated with an improvement in the diagnosis and management of EPI and related complications in CP, PDAC, and s/p pancreatic resection. |
| format | Article |
| id | doaj-art-11cc792ae87b4adbb62e38840cb70a57 |
| institution | Kabale University |
| issn | 2772-5723 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Gastro Hep Advances |
| spelling | doaj-art-11cc792ae87b4adbb62e38840cb70a572025-01-18T05:05:33ZengElsevierGastro Hep Advances2772-57232025-01-0141100541Impact of Order Set on Exocrine Pancreatic Insufficiency in Chronic Pancreatitis, Pancreatic Cancer, and Pancreatic ResectionMichael Ladna0Ishaan Madhok1Adnan Bhat2Nicole Ruiz3Jackson Brown4Jake Wilson5Peter Jiang6Robert Taylor7Mark Radetic8John George9Christopher Forsmark10Department of Internal Medicine, University of Florida, Gainesville, Florida; Correspondence: Address correspondence to: Michael Ladna, MD, Associate Physician of Hospital Medicine, Division of Hospital Medicine, University of California Davis Health, 4301 X Street, Sacramento, 95817 California.Department of Internal Medicine, University of Florida, Gainesville, FloridaDepartment of Internal Medicine, University of Florida, Gainesville, FloridaDepartment of Internal Medicine, University of Florida, Gainesville, FloridaDepartment of Internal Medicine, University of Florida, Gainesville, FloridaDepartment of Internal Medicine, University of Florida, Gainesville, FloridaDepartment of Internal Medicine, University of Florida, Gainesville, FloridaDivision of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Florida, Gainesville, FloridaDivision of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Florida, Gainesville, FloridaDivision of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Florida, Gainesville, FloridaDivision of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Florida, Gainesville, FloridaBackground and Aims: Enzyme insufficiency (EPI) is common in chronic pancreatitis (CP), pancreatic ductal adenocarcinoma (PDAC), and after pancreatic resection. 40%–50% of CP patients and 70%–80% of PDAC patients develop EPI. 1/3rd of these patients are prescribed Pancreatic enzyme replacement therapy (PERT), often at an inadequate dose, with evidence that this leads to increased morbidity and mortality. This study aimed to develop and implement an EPIC-based best practice alert (BPA) and smart set to improve the management of EPI. Methods: A retrospective analysis of all patients with International Classification of Diseases codes for EPI, CP, and PDAC or CPT code for pancreatic resection from Feb-2018 to Feb-2021. Appropriate use of PERT was defined as ≥ 40,000 units of lipase with each meal. The BPA and smart set were implemented into the electronic medical record in Feb-2020. The BPA fired if the patient was already on PERT or if an order for PERT was placed and directed the clinician to the smart set which provided PERT formulations each prefilled to the minimum therapeutic dose of 40,000 units of lipase. Results: A significant increase in the proportion of patients on minimum therapeutic dose of PERT from 61.9% to 72.9% (P ≤ .001). Ordering of pancreatic elastase, A1c, vitamin D, and dual X-ray absorptiometry increased from 20.4% to 29.9% (P < .001), 54.7%–62.1% (P = .001), 30.9%–48.1% (P < .001) and 10%–18% (P < .001), respectively. The BPA triggered a total of 30,838 times resulting in the smart being opened a total of 624 (2.02%) times over 24 months. Conclusion: The BPA and smart set were associated with an improvement in the diagnosis and management of EPI and related complications in CP, PDAC, and s/p pancreatic resection.http://www.sciencedirect.com/science/article/pii/S2772572324001353Exocrine pancreatic insufficiencyPancreatic enzyme replacement therapyChronic pancreatitisPancreatic cancerPancreatic resection |
| spellingShingle | Michael Ladna Ishaan Madhok Adnan Bhat Nicole Ruiz Jackson Brown Jake Wilson Peter Jiang Robert Taylor Mark Radetic John George Christopher Forsmark Impact of Order Set on Exocrine Pancreatic Insufficiency in Chronic Pancreatitis, Pancreatic Cancer, and Pancreatic Resection Gastro Hep Advances Exocrine pancreatic insufficiency Pancreatic enzyme replacement therapy Chronic pancreatitis Pancreatic cancer Pancreatic resection |
| title | Impact of Order Set on Exocrine Pancreatic Insufficiency in Chronic Pancreatitis, Pancreatic Cancer, and Pancreatic Resection |
| title_full | Impact of Order Set on Exocrine Pancreatic Insufficiency in Chronic Pancreatitis, Pancreatic Cancer, and Pancreatic Resection |
| title_fullStr | Impact of Order Set on Exocrine Pancreatic Insufficiency in Chronic Pancreatitis, Pancreatic Cancer, and Pancreatic Resection |
| title_full_unstemmed | Impact of Order Set on Exocrine Pancreatic Insufficiency in Chronic Pancreatitis, Pancreatic Cancer, and Pancreatic Resection |
| title_short | Impact of Order Set on Exocrine Pancreatic Insufficiency in Chronic Pancreatitis, Pancreatic Cancer, and Pancreatic Resection |
| title_sort | impact of order set on exocrine pancreatic insufficiency in chronic pancreatitis pancreatic cancer and pancreatic resection |
| topic | Exocrine pancreatic insufficiency Pancreatic enzyme replacement therapy Chronic pancreatitis Pancreatic cancer Pancreatic resection |
| url | http://www.sciencedirect.com/science/article/pii/S2772572324001353 |
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