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.
Key words
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Article info
Publication history
Published online: September 29, 2022
Accepted:
August 10,
2022
Received:
January 15,
2022
Footnotes
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.
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© 2022 by the American Society for Surgery of the Hand. All rights reserved.
