Reducing daily dosing in opioid prescriptions in 11 safety net emergency departments

• Published in: The American journal of emergency medicine Vol. 71; pp. 63 - 68
• Main Authors: Shin, Dawi, Cho, Hyung J., Alaiev, Daniel, Tsega, Surafel, Talledo, Joseph, Zaurova, Milana, Chandra, Komal, Alarcon, Peter, Garcia, Mariely, Krouss, Mona
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2023; Elsevier Limited
• Subjects: Acetaminophen; Analgesics; Default; Default nudge; Disease control; Dosage; Drug dosages; Drug overdose; Drug use; Electronic health records; Electronic medical records; Emergency medical care; Equality; Hospitals; Intervention; Morphine; Narcotics; Opioid prescription; Opioids; Outcome assessment; Overdose; Oxycodone; Palliative care; Patient safety; Physicians; Prescriptions; Quality control; Quality improvement; Regression analysis; United States > US; New York City New York; Quality improvement; PDMP; Default nudge; CDC; Patient safety; MMED; Opioid prescription; NYC H + H; Outcome assessment; EHR; ED
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2023.06.005

The United States continues to face a significant issue with opioid misuse, overprescribing, dependency, and overdose. Electronic health record (EHR) interventions have shown to be an effective tool to modify opioid prescribing behaviors. This quality improvement project describes an EHR intervention to reduce daily dosing in opioid prescriptions in 11 emergency departments (ED) across the largest safety net health system in the US.
The primary outcome measure was the rates of oxycodone-acetaminophen 5–325 mg prescriptions exceeding 50 morphine milligram equivalents per day (MMED) pre- vs. post-intervention; and stratified by individual hospitals and provider type.
The defaults for dose and frequency were uniformly changed to ‘every 6 hours as needed’ and ‘1 tablet’, respectively, across 11 EDs.
The percentage of prescriptions greater than or equal to 50 MMED decreased from 46.0% (1624 of 3530 prescriptions) to 1.6% (52 of 3165 prescriptions) (96.4% relative reduction; p < 0.001). All 11 hospitals had a significant reduction in prescriptions exceeding 50 MMED. Nurse practitioners had the highest relative reduction of prescriptions exceeding 50 MMED at 100% (p < 0.001), and the attendings/fellows had the lowest relative reduction at 95.6% (p < 0.001).
Default nudges are a simple yet powerful intervention that can strongly influence opioid prescribing patterns.