Abstract
Purpose: We hypothesized that a pain management prescribing tool embedded in the electronic health record system of a multihospital health care system would decrease prescription opioids for postoperative pain by hand, orthopedic, plastic, and spine surgeons. Methods: A prescribing tool for postoperative pain was designed for hand, orthopedic, plastic, and spine surgeons and implemented into electronic discharge order sets in a 10-hospital health care system. Stakeholders were educated on tool use in person and/or by email on 2 occasions. A dashboard was created to monitor opioid pill quantities and morphine milligram equivalents (MMEs) prescribed. Overall compliance with the suggested opioid amounts was assessed for 20 months after tool implementation. A subgroup of 6 hand surgeons, one of whom was instrumental in designing the tool, were evaluated for MMEs prescribed, opioid refills, patient emergency room visits, and patient readmissions within 30 days after discharge. Comparisons in this subgroup were made from 12 months before to 15 months after tool implementation. Results: The mean system-wide compliance with the suggested opioid pill quantities and MMEs prescribed in all 4 specialties improved by less than 5%. In the subgroup of hand surgeons, 5 of whom championed tool use, prescribed MMEs decreased by 10% during each of the 4 quarters before launching the tool and contracted an additional 26% in the first quarter after tool implementation. Opioid refills held steady at 5%, and there were no emergency room visits or readmissions within 30 days after discharge in this patient subgroup. Conclusions: The prescribing tool had a negligible impact on system-wide compliance with suggested prescription opioid pill quantities and MMEs. In a small group of surgeons who championed the use of the tool, there was a significant and sustained decline in MMEs prescribed without adversely impacting patient refills, emergency room visits, or readmissions. Clinical relevance: An electronic prescribing tool to assist surgeons in lowering opioid prescription pill quantities and MMEs may have a negligible impact on prescribing behavior in a multihospital health care system.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1035-1044 |
| Number of pages | 10 |
| Journal | Journal of Hand Surgery |
| Volume | 47 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 2022 |
Funding
This work was supported by a grant from the American Foundation for Surgery of the Hand (Award 2834: AFSH Clinical Research Grant). L.C. Petito reported receiving unrelated research support from Omron Healthcare Co. Ltd. The rest of the authors report that no benefits in any form have been received or will be received related directly or indirectly to the subject of this article. This study was funded by a grant from the American Foundation for Surgery of the Hand. The authors acknowledge Xylina Foxworth, Aubry Chambers, Jonah Stulberg, Theresa Ng, Ming Zhang, Barbara Buckley, Anne Bobb, David Cooke, Jason Ko, Robert Christian, Nöel Burks, Misty Kirby-Nolan, Ashley Manternach, Gretchen York, Gavin Blyth, Matthew Hartwell, and Vehniah Tjong for their assistance with this opioid reduction project. This work was supported by a grant from the American Foundation for Surgery of the Hand (Award 2834: AFSH Clinical Research Grant). L.C. Petito reported receiving unrelated research support from Omron Healthcare Co. Ltd. The rest of the authors report that no benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Keywords
- Electronic clinical decision support
- electronic health records
- opioid prescribing
- opioids
- postoperative pain
ASJC Scopus subject areas
- Surgery
- Orthopedics and Sports Medicine