Background: The opioid crisis is in the forefront as a public health emergency and there are concerns regarding addiction stemming from opioid prescriptions written in the acute setting, such as the ED and hospitals.
Study design: Quality improvement project, randomized.
Setting: Two large EDs in San Francisco and Oakland, Calif.
Synopsis: In five 4-week blocks, the prepopulated opioid dispense quantities were altered on a block randomized treatment schedule without prior knowledge by the prescribing practitioners with the default dispense quantities of 5, 10, 15, and null (prescriber determined dispense quantity). Opiates included oxycodone, oxycodone/acetaminophen, and hydrocodone/acetaminophen. The primary outcome was number of opioid tablets prescribed at discharge from the ED. In this study, a total of 104 health care professionals issued 4,320 opioid study prescriptions. With use of linear regression, an increase of 0.19 tablets prescribed was found for each tablet increase in default quantity. When comparing default pairs – that is, 5 versus 15 tablets – a lower default was associated with a lower number of pills prescribed in more than half of the comparisons. Limitations of this study include a small sample of EDs, and local prescribing patterns can vary greatly for opioid prescriptions written. In addition, the reasons for the prescriptions were not noted.
Bottom line: Default EMR opioid quantity settings can be used to decrease the quantity of opioids prescribed.
Citation: Montoy JCC et al. Association of default electronic medical record settings with health care professional patterns of opioid prescribing in emergency departments: A randomized quality improvement study. JAMA Intern Med. 2020;180(4):487-93.
Dr. Wang is a hospitalist and associate professor of medicine at University of Texas Health, San Antonio.