The following is a summary of “Reducing daily dosing in opioid prescriptions in 11 safety net emergency departments,” published in the September 2023 issue of Emergency Medicine by Shin, et al.
The United States grapples with a persistent challenge involving opioid misuse, overprescribing, dependence, and overdose. Various interventions, particularly those involving Electronic Health Records (EHR), have demonstrated efficacy in modifying opioid prescription behaviors. For a quality improvement initiative study, researchers focused on an EHR intervention designed to curtail the daily dosing of opioid prescriptions in 11 Emergency Departments (EDs) within the largest safety net healthcare system in the United States.
The primary outcome measure for this project was the evaluation of rates of oxycodone-acetaminophen 5–325 mg prescriptions that exceeded 50 Morphine Milligram Equivalents per day (MMED) before and after the intervention. The assessment was further stratified according to individual hospitals and provider types.
The intervention implemented uniform modifications to the default settings for dosage and frequency. Specifically, the dosing was adjusted to ‘every 6 hours as needed,’ and the frequency was set at ‘1 tablet’ across all 11 EDs.
The results were striking, with a noteworthy 96.4% relative reduction (P < 0.001) observed in the percentage of prescriptions exceeding 50 MMED. This dropped from 46.0% (1,624 out of 3,530 prescriptions) to just 1.6% (52 out of 3,165 prescriptions) post-intervention. Importantly, all 11 hospitals witnessed a substantial reduction in prescriptions that exceeded 50 MMED. Furthermore, when analyzed by provider type, nurse practitioners exhibited the most remarkable relative reduction at 100% (P < 0.001), while attendings/fellows showed a slightly lower relative reduction at 95.6% (P < 0.001).
In conclusion, the study highlighted the effectiveness of employing default nudges as a straightforward yet highly impactful intervention for influencing and reshaping opioid prescription practices.
Source: sciencedirect.com/science/article/abs/pii/S0735675723003005
