Please use this identifier to cite or link to this item: http://hdl.handle.net/1946/35647
Introduction: Overuse of opioid analgesics and high rates of death related to opioids, referred to as the opioid epidemic, is a major public health crisis in the US. Overprescribing of opioids after surgeries has contributed to this problem. Electronic medical records (EMR) systems can auto-populate a default number of opioids that are prescribed at time of discharge, and this tool can be used to alter prescribing practices. The aim of this study was to examine the association between lowered default pill counts with changed prescribing behaviors after cardiac surgery.
Methods: On May 18 2017, the default number of pills prescribers see in EMRs in the Yale New Haven Health System was lowered from 30 to 12. Patients undergoing coronary artery grafts, valve surgeries, and thoracic aortic aneurysm surgeries were included in this study. Data was gathered and stratified in to two groups: First, one year prior (May 18 2016 to May 17 2017); and second, one year following (from May 18 2017 to May 17 2018) the default change, and actual amount of opioid prescribed was compared between the two groups.
Results: A total of 1741 patient charts were reviewed, 832 before the change and 909 after the change. Significant changes were seen in prescribing practices, where the average amount of opioid prescribed was about 25% lower after the change. This amounted to about 15 fewer pills of 5 mg morphine for each patient. A linear regression model adjusting for other factors determined a prescribing difference of 75.2 MME per prescription (p < 0.01). In addition, a significant decrease in opioids prescribed was found for each type of procedure.
Conclusions: Lowering the default opioid pill count in EMRs is a simple, cheap and effective intervention to change prescribing behavior and promote judicious prescribing of opioids after cardiac surgery.
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