Accepted for/Published in: JMIR Medical Informatics
Date Submitted: Sep 9, 2019
Date Accepted: Jan 14, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Examining Discrepancies in Opioid Prescriptions: Written versus Calculated Durations
ABSTRACT
Background:
The United States is in the midst of an opioid epidemic. Long term use of opioid medications is associated with an increased risk of dependence. The CDC makes specific recommendations regarding opioid prescribing, including that prescription quantities should not exceed the intended duration of treatment.
Objective:
The purpose of this study was to determine if opioid prescription quantities written at our institution exceed intended duration of treatment, and if enhancements to our electronic health record improved any discrepancies.
Methods:
We examined the opioid prescriptions written at our institution for a 22-month period. We examined the duration of treatment documented in the prescription itself, and calculated a duration based on the quantity of tablets and doses per day. We determined if requiring documentation of the prescription duration effected these outcomes.
Results:
We reviewed 69,928 opioid prescriptions of which 17.2% had a calculated duration that was longer than what was documented in the prescription. Making the duration a required field significantly reduced this discrepancy (18.1% vs 16.6% [P<0.001]), but did not eliminate it.
Conclusions:
Health information technology vendors should develop tools which, by default, accurately represent prescription durations and/or modify doses and quantities dispensed based on provider entered durations. This would potentially reduce unintended prolonged opioid use, and reduce the potential for long term dependence.
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