Best Practice Alerts Informed by Inpatient Opioid Intake to Reduce Opioid Prescribing after Surgery (PRIOR): A...

Area of Science:

• Medical Informatics
• Pain Management
• Public Health

Background:

• Overprescription of opioids post-surgery is a significant issue, contributing to nonmedical use.
• Residual opioids can be misused, highlighting the need for optimized prescribing practices.

Purpose of the Study:

• To evaluate if an electronic health record (EHR) decision-support tool can decrease opioid discharge prescriptions after inpatient surgery.
• To test the hypothesis that tailored EHR alerts reduce postoperative opioid prescribing.

Main Methods:

• A cluster randomized multiple crossover trial involving 21,689 surgical inpatient discharges across four hospitals.
• An EHR decision-support tool provided alerts for opioid discharge prescriptions exceeding recommended amounts during active periods.
• Outcomes measured included oral morphine milligram equivalents (MME) prescribed at discharge and additional opioid prescriptions within 28 days.

Main Results:

• The median postdischarge opioid prescription was 75 MME with alerts active versus 100 MME with alerts inactive (ratio of geometric means: 0.95; P = 0.586).
• The decision-support tool did not significantly impact opioid prescribing amounts or the use of combination opioid/nonopioid medications.
• No association was found between the alert system and additional opioid prescriptions within 28 days post-discharge.

Conclusions:

• An EHR-based decision-support tool did not reduce opioid discharge prescribing for postoperative patients.
• The findings were observed within the context of a strong state-wide opioid education campaign.
• Opioid prescribing alerts may be effective in different clinical settings or with modified implementation.