Changes in Opioid Prescription Rates at Discharge After Targeted Provider Education in the Emergency Department

Abstract

Introduction: Opioid-related mortality continues to increase in the United States and emergency departments (ED) are a source of opioid prescribing. A review was conducted of prescribing practices and all prescribers were given targeted education to modify prescribing patterns and facilitate guideline recommended opioid prescribing. This study seeks to evaluate prescribing practices after implementation of the education that occurred December 23 to 31, 2019 on prescribing habits. The pre-education group was defined as the period of January 1, 2019 to December 31, 2019. The post-education group was defined as the period of January 1, 2020 to December 31, 2020. Objective: Evaluate the total number of prescriptions and prescription doses in morphine milligram equivalent (MME) prescribed between pre-education and post-education groups. Secondary endpoints will be an evaluation of the number of doses, length of therapy, and the rates of prescribing per 100 discharges. Methods: A retrospective chart review at a single center suburban ED was conducted comparing prescribing after education was provided. Patients were excluded if they were under the age of 18 years, admitted or transferred to an acute care facility, or prescribed an opioid for a non-analgesic purpose. Results: There was a 34% reduction in the total number of opioid prescriptions from the pre-education group compared to the post-education group (4,253 to 2,818). Between the 2 groups, there was a reduction in MME of 8.8 (92.2 ± 60.4 vs 83.4 ± 60), P < 0.001, number of tablets by 0.9 tablets (13.6 ± 5.2 vs 12.7 ± 5.4), P < 0.001, and day supply by 0.12 (4.45 ± 2.1 vs 4.33 ± 2.0), P = 0.017. Percentage of the total number of opioid prescriptions per 100 discharges decreased by 0.4% from 5.1% to 4.7%. Conclusion: After targeting providers through education, a reduction in opioid prescribing was identified through all endpoints.