Abstract
BackgroundThe United States is in an opioid epidemic. Passive decision support in the electronic health record (EHR) through opioid prescription presets may aid in curbing opioid dependence.ObjectiveThe objective of this study is to determine whether modification of opioid prescribing presets in the EHR could change prescribing patterns for an entire hospital system.MethodsWe performed a quasi-experimental retrospective pre–post analysis of a 24-month period before and after modifications to our EHR’s opioid prescription presets to match Centers for Disease Control and Prevention guidelines. We included all opioid prescriptions prescribed at our institution for nonchronic pain. Our modifications to the EHR include (1) making duration of treatment for an opioid prescription mandatory, (2) adding a quick button for 3 days’ duration while removing others, and (3) setting the default quantity of all oral opioid formulations to 10 tablets. We examined the quantity in tablets, duration in days, and proportion of prescriptions greater than 90 morphine milligram equivalents/day for our hospital system, and compared these values before and after our intervention for effect.ResultsThere were 78,246 prescriptions included in our study written on 30,975 unique patients. There was a significant reduction for all opioid prescriptions pre versus post in (1) the overall median quantity of tablets dispensed (54 [IQR 40-120] vs 42 [IQR 18-90]; P<.001), (2) median duration of treatment (10.5 days [IQR 5.0-30] vs 7.5 days [IQR 3.0-30]; P<.001), and (3) proportion of prescriptions greater than 90 morphine milligram equivalents/day (27.46% [10,704/38,976; 95% CI 27.02%-27.91%] vs 22.86% [8979/39,270; 95% CI 22.45%-23.28%]; P<.001).ConclusionsModifications of opioid prescribing presets in the EHR can improve prescribing practice patterns. Reducing duration and quantity of opioid prescriptions could reduce the risk of dependence and overdose.
Highlights
The opioid epidemic is a public health emergency unlike any other [1,2,3]
In August 2018, we implemented a number of interventions in our electronic health record (EHR)’s Computerized provider order entry (CPOE): (1) we made the duration of treatment for an opioid prescription mandatory, (2) we provided a quick button for 3 days’ duration on all opioid prescriptions while removing all other quick buttons, and (3) we set the default quantity to 10 tablets for all oral opioid formulations, and removed any departmental variations
There were 128,933 non-medical assisted treatment (MAT) opioid prescriptions written during our study period
Summary
The opioid epidemic is a public health emergency unlike any other [1,2,3] The roots of this crisis are founded in over 30 years of influential guidelines, marketing campaigns, and advertising that led to an increase in opioid prescriptions [4,5,6,7,8]. There was a significant reduction for all opioid prescriptions pre versus post in (1) the overall median quantity of tablets dispensed (54 [IQR 40-120] vs 42 [IQR 18-90]; P
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