Electronic medical record-based interventions to encourage opioid prescribing best practices in the emergency department

Courtney M Smalley; Marc A Willner; McKinsey R Muir; Stephen W Meldon; Bradford L Borden; Fernando J Delgado; Baruch S Fertel

doi:10.1016/j.ajem.2019.158500

Electronic medical record-based interventions to encourage opioid prescribing best practices in the emergency department

Am J Emerg Med. 2020 Aug;38(8):1647-1651. doi: 10.1016/j.ajem.2019.158500. Epub 2019 Oct 14.

Authors

Courtney M Smalley¹, Marc A Willner², McKinsey R Muir³, Stephen W Meldon¹, Bradford L Borden¹, Fernando J Delgado³, Baruch S Fertel⁴

Affiliations

¹ Emergency Services Institute, Cleveland Clinic Health System, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
² Department of Pharmacy, Cleveland Clinic Health System, Cleveland, OH, USA.
³ Emergency Services Institute, Cleveland Clinic Health System, Cleveland, OH, USA.
⁴ Emergency Services Institute, Cleveland Clinic Health System, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA; Enterprise Quality and Safety, Cleveland Clinic Health System, Cleveland, OH, USA.

PMID: 31718956
DOI: 10.1016/j.ajem.2019.158500

Abstract

Objective: Overdose from opioids has reached epidemic proportions. Large healthcare systems can utilize existing technology to encourage responsible opioid prescribing practices. Our study measured the effects of using the electronic medical record (EMR) with direct clinician feedback to standardize opioid prescribing practices within a large healthcare system.

Methods: This retrospective multicenter study compared a 12 month pre- and post-intervention in 14 emergency departments after four interventions utilizing the EMR were implemented: (1) deleting clinician preference lists, (2) defaulting dose, frequency, and quantity, (3) standardizing formulary to encourage best practices, and (4) creating dashboards for clinician review with current opioid prescribing practices. Outlying clinicians received feedback through email and direct counseling. Total number of opioid prescriptions per 100 discharges pre- and post-intervention were recorded as primary outcome. Secondary outcomes included number of prescriptions per 100 discharges/clinician exceeding 3-day supply (defined as 12 tablets), number exceeding 30 morphine equivalent daily dose (MEDD)/day, and number of non-formulary prescriptions.

Results: There were >700,000 discharges during pre- and post-intervention periods. Percentage of total number opioid prescriptions per 100 discharges decreased from 14.4% to 7.4%, a 7.0% absolute reduction, (95% CI,6.9%-7.2%). There was a 5.9% to 0.7% reduction in prescriptions exceeding 3-days, (95% CI, 5.1%-5.3%), a 4.3% to 0.3% reduction in prescriptions exceeding 30 MEDD, (95% CI, 3.9%-4.0%), and a 0.3% to 0.1% reduction in non-formulary prescriptions, (95% CI, 0.2%-0.3%).

Conclusions: A multi modal approach using EMR interventions which provide real time data and direct feedback to clinicians can facilitate appropriate opioid prescribing.

Keywords: Emergency departments; Narcotic; Opioid; Pain; Prescription policy.

Publication types

Multicenter Study

MeSH terms

Analgesics, Opioid / therapeutic use*
Drug Overdose / prevention & control
Electronic Health Records*
Emergency Service, Hospital*
Female
Humans
Inappropriate Prescribing / prevention & control*
Male
Ohio
Practice Patterns, Physicians' / standards*
Retrospective Studies

Substances

Analgesics, Opioid