Lowering Default Pill Counts in EMRs May Effectively Reduce Postoperative Opioid Prescription Numbers

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The effects of a reduction in default pill count from 30 to 12 in an electronic medical record system were assessed.
The effects of a reduction in default pill count from 30 to 12 in an electronic medical record system were assessed.

According to a recent study published in JAMA Surgery, lowering the default number of opioid pills prescribed in an electronic medical record (EMR) system can decrease the amount of opioid medication prescribed after procedures significantly.

For this preintervention/postintervention study, researchers assessed the effects of a reduction in default pill count from 30 to 12 in an EMR system. The investigators examined postprocedural prescribing patterns at a multihospital healthcare system using Epic EMR 3 months before and 3 months after implementing the default change.

Prior to the default change, 1447 participants (average age, 54.4) who underwent one of the hospital system's 10 most frequent outpatient procedures were prescribed a median of 30 opioid pills per prescription. After the change, 1463 participants (average age, 54.5) were prescribed a median of 20 pills per prescription (P <.001).

Over the study period, the percentage of prescriptions written for 30 pills decreased from 39.7% to 12.9% (P <.001), and the percentage of prescriptions for 12 pills increased from 2.1% to 24.6% (P <.001). Prescriptions written for 20 pills increased from 12.2% to 19.6% (P <.001).

The number of pills prescribed was reduced by 5.22 pills per prescription after the default change, with a total decrease of 34.41 morphine milligram equivalents per prescription. Opioid refill rates were comparable before and after the default change (3% vs 1.5%, respectively; P =.41).

Study limitations include the trial's brief duration, precluding assessment of the long-term effects of this change.

“Lowering the default quantity of opioid pills prescribed after procedures via an EMR system is a simple, effective, cheap, and potentially wide-reaching intervention that can be harnessed to help change the culture of opioid overprescribing among health care professionals,” concluded the study authors.

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Reference

Chiu AS, Jean RA, Hoag JR, Freedman-Weiss M, Healy JM, Pei KY. Association of lowering default pill counts in electronic medical record systems with postoperative opioid prescribing [published online July 18, 2018] JAMA Surg. doi:10.1001/jamasurg.2018.2083

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