Association of Default Electronic Medical Record Settings With Health Care Professional Patterns of Opioid Prescribing in Emergency Departments

Abstract

IMPORTANCE Prescription opioids play a significant role in the ongoing opioid crisis. Guidelines and physician education have had mixed success in curbing opioid prescriptions, highlighting the need for other tools that can change prescriber behavior, including nudges based in behavioral economics.OBJECTIVE To determine whether and to what extent changes in the default settings in the electronic medical record (EMR) are associated with opioid prescriptions for patients discharged from emergency departments (EDs). DESIGN, SETTING, AND PARTICIPANTSThis quality improvement study randomly altered, during a series of five 4-week blocks, the prepopulated dispense quantities of discharge prescriptions for commonly prescribed opioids at 2 large, urban EDs. These changes were made without announcement, and prescribers were not informed of the study itself. Participants included all health care professionals (physicians, nurse practitioners, and physician assistants) working clinically in either of the 2 EDs. Data were collected from

Reduction in Hospital System Opioid Prescribing for Acute Pain Through Default Prescription Preference Settings: Pre–Post Study (Preprint)

“…RenderX demonstrated that each tablet increase in preset yielded an increase of 0.19 tablets prescribed, and lower default quantities were associated with lower number of pills in 8 of 15 pairwise comparisons [25]. These results support our approach that modifications to prescription presets are an effective way to enact change in opioid prescribing.…”

“…Despite a number of publications demonstrating reductions in opioid prescribing through presets [22,23,25], to our knowledge this research is the first to demonstrate reduction in overall opioid prescribing and prescribing of multiple individual opioids for an entire hospital system. Our hospitals and ambulatory clinics are located in one of the most lethal counties in one of the most lethal states associated with the opioid epidemic [38][39][40].…”

“…In order to curb overprescribing and reduce quantities of tablets, CPOE-linked interventions focus on preset defaulted prescription settings [22][23][24]. Previous studies have shown that the introduction or modification of opioid prescription presets has demonstrated reductions of tablet quantities and prescription MME for postsurgical patients [22], as well as significant reductions in the number of tablet quantities dispensed in the emergency department (ED) [23,25]. These studies suggest that modification of EHR-linked CPOE settings is a simple, inexpensive, and effective method of reducing the number of tablets associated with opioid prescriptions.…”

“…These studies suggest that modification of EHR-linked CPOE settings is a simple, inexpensive, and effective method of reducing the number of tablets associated with opioid prescriptions. However, all previous studies have focused on isolated emergency [23][24][25][26][27] or surgery departments [22]. We are unaware of any research examining the effects of modifications to opioid presets across an entire hospital system.…”

Effect of Changing Electronic Health Record Opioid Analgesic Dispense Quantity Defaults on the Quantity Prescribed

“…In 10 recent studies, implementing a new or lower default dispense quantity for opioid analgesics, either alone or as part of a package of interventions, was associated with reductions in the quantity of new prescriptions. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 In 2 studies, removing defaults, and therefore requiring prescribers to make an active choice with each prescription, yielded mixed results. 23 , 25 …”