JMIR Publications

ABSTRACT

Background:

The 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.

Objective:

To determine whether modification of opioid prescribing presets in the electronic health record could change prescribing patterns for an entire hospital system.

Methods:

We 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 CDC guidelines. We included all opioid prescriptions prescribed at our institution for non-chronic pain. Our modifications to the EHR include: 1) Making duration of treatment for an opioid prescription required, 2) adding a quick button for three 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 MME/day for our hospital system, and compared these values before and after our intervention for effect.

Results:

There were 78,246 prescriptions included in our study written on 30,975 unique patients. There was a significant reduction for all opioid prescriptions pre vs. post in 1) the overall median quantity of tablets dispensed (54 [IQR 40-120] vs. 42 [IQR 18-90], P<0.001), 2) median duration of treatment (10.5 days [IQR 5.0-30] vs. 7.5 days [IQR 3.0 – 30], P<0.001) and 3) proportion of prescriptions greater than 90 MME/day (27.46% [95%CI 27.02%-27.91%] vs 22.86% [95%CI 22.45%-23.28%], P<0.001).

Conclusions:

Modifications of opioid prescribing presets in the EHR can improve prescribing practice patterns. To our knowledge we are the first to demonstrate this kind of successful intervention on an entire hospital system. Reducing duration and quantity of opioid prescriptions could reduce risk of dependence and overdose.