Default EMR setting could result in less ED opioid prescribing

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Opioid prescriptions that contain a large number of tablets in the first fill often lead to long-term use and more leftover pills, but implementing a default setting in the EMR that limits the number of tablets in a prescription could "nudge" physicians to prescribe fewer opioids, according to a recent study.

The study, commissioned by Philadelphia-based Penn Medicine and published this week in the Journal of General Internal Medicine, analyzed prescription data from the emergency departments at two Penn Medicine facilities in Philadelphia — the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center — between late 2014 and mid-2015. In 2015, researchers placed a default prescribing setting on the EMR that limited the amount of opioid pills included in a patient's initial prescription to 10. The research team compared weekly prescribing patterns for oxycodone 5mg/acetaminophen 325 mg over the 41-week period.

Researchers found that the physicians prescribed fewer opioid pills to patients when the EMR default setting was set to 10 tablets, even though clinicians could opt-out by selecting a quantity of 20 tablets.

Initial prescriptions for that reduced amount increased by 22 percent, from a pre-default rate of 21 percent to 43 percent after the default option had been introduced. The number of prescriptions written for more tablets decreased — those written for 20 tablets dropped nearly 7 percent, and prescriptions for 11 to 19 tablets dropped over 13 percent.

"Our results represent a promising and much-needed scalable approach that could successfully nudge physicians managing acute pain to prescribe smaller doses of opioid medications for those who need them," lead author M. Kit Delgado, MD, an assistant professor of emergency medicine and epidemiology at the University of Pennsylvania's Perelman School of Medicine, said in a news release.

"We know that prescribing too many opioid tablets for acute pain increases a patient's risk for long-term use or the potential to be abused if left in the medicine cabinet, so making it easier to prescribe quantities consistent with current guidelines while still keeping physician autonomy is an important part of addressing the opioid crisis we're facing in this country," Dr. Kit Delgado added.

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