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Effect of a Standardized Electronic Medical Record Order Set on Opioid Prescribing after Tonsillectomy

Joshua D Horton1, Corinne Corrigan2, Terral Patel3

  • 1Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|March 18, 2020
PubMed

Insights

A new electronic medical record (EMR)-based order set significantly improved opioid prescribing after pediatric tonsillectomy. This intervention enhanced the quality and safety of pain management, reducing variability and eliminating high-risk prescriptions without impacting patient outcomes.

Area of Science:

  • Pediatric Surgery
  • Pain Management
  • Health Informatics

Background:

  • Opioid prescribing after pediatric tonsillectomy is often inconsistent and excessive.
  • Approximately 5% of children develop new persistent opioid use post-tonsillectomy.

Purpose of the Study:

  • To improve post-tonsillectomy opioid prescribing practices in children.
  • To implement and evaluate a standardized electronic medical record (EMR)-based order set for pain management.

Main Methods:

  • Retrospective chart review comparing tonsillectomies before and after EMR order set implementation.
  • Analysis of opioid and nonopioid analgesic (NOA) prescription characteristics.
  • Evaluation of outcomes including hemorrhage and readmission.

Main Results:

  • Increased utilization of NOAs and reduced doses of opioids prescribed post-intervention.
  • Significant decrease in prescription variability and elimination of dangerously high outlier opioid doses.
  • No significant differences observed in pain control, hemorrhage, emergency department visits, or readmissions.

Conclusions:

  • An EMR-based order set intervention successfully improved the quality and safety of opioid prescribing after tonsillectomy.
  • The standardized order set provides a foundation for optimizing pain control and safety through titration of analgesics.
Abstract

Keywords:
electronic medical recordnarcoticsopioidspediatricquality improvementtonsillectomy

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