Faculty Collaboration Database

Evaluating the Impact of Auto-Calculation Settings on Opioid Prescribing at an Academic Medical Center. Jt Comm J Qual Patient Saf 2019 Jun;45(6):416-422

Date

04/03/2019

Pubmed ID

30935884

DOI

10.1016/j.jcjq.2019.02.010

Scopus ID

2-s2.0-85063548116 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

BACKGROUND: Overprescribing of opioids is a key contributor to the opioid epidemic, which has led to a substantial increase in overdose deaths. The purpose of this study was to evaluate the discontinuation of a dispense quantity automatic calculation function on prescribing of as needed (PRN) opioids.

METHODS: During the implementation of a new electronic health record (EHR), Vanderbilt University Medical Center discontinued functionality that autocalculated the maximum needed dispense quantity for PRN outpatient prescription opioids. This study analyzed prescribing trends for immediate-release hydrocodone- and oxycodone-containing prescriptions 90 days before and after implementation of the new EHR.

RESULTS: A total of 21,323 prescriptions were analyzed in the preintervention group and 22,730 prescriptions in the postintervention group. Discontinuing the autocalculation functionality resulted in a mean decrease of 1.4 dispense units per prescription (58.5 vs. 57.1; p = 0.006) across all patient care areas. The most significant finding was a 10.5% relative decrease in dispense units from inpatient discharge prescriptions (37.2 vs. 33.3; p < 0.001). In the new EHR, PRN oxycodone products defaulted to a dispense quantity of 30, which resulted in a 142.0% (10.0% vs. 24.2%; p < 0.001) increase in oxycodone prescriptions ordered for 30 dispense units but was a net reduction in the doses dispensed per oxycodone prescription.

CONCLUSION: This study suggests that removing the autocalculation functionality reduced the number of opioid units ordered. In addition, using a default dispense quantity for PRN opioid prescriptions may decrease the number of opioid dispense units per prescription.

Author List

Crothers G, Edwards DA, Ehrenfeld JM, Woo E, McCluggage L, Lobo B

Author

Jesse Ehrenfeld MD, MPH Sr Associate Dean, Director, Professor in the Advancing a Healthier Wisconsin Endowment department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Academic Medical Centers
Adult
Aged
Analgesics, Opioid
Cohort Studies
Electronic Health Records
Female
Humans
Hydrocodone
Inappropriate Prescribing
Male
Middle Aged
Oxycodone
Practice Patterns, Physicians'