Choice Architecture in Opioid Safety Alerting

Area of Science:

• Health Informatics
• Clinical Decision Support Systems
• Public Health Interventions

Background:

• Growing need for effective clinical decision support (CDS) integrated into electronic health records (EHR).
• Choice architecture design strategies show potential for enhancing CDS effectiveness.
• Opioid overdose prevention necessitates improved prescribing practices, including naloxone co-prescription.

Purpose of the Study:

• To evaluate the impact of implementing an opioid risk alert with choice architecture on naloxone prescribing rates.
• To assess the effectiveness of different choice architecture designs (opt-in vs. active choice) in a CDS alert.
• To determine if revisions to the CDS alert could reduce alert volumes while improving outcomes.

Main Methods:

• Implementation of an opioid risk alert within an EHR system.
• Utilized an opt-in choice architecture for the initial alert recommending naloxone.
• Revised the alert to an active choice design in a subsequent implementation phase.
• Monitored naloxone prescription rates and alert volumes over time.
• Conducted an educational campaign alongside alert implementation.

Main Results:

• Significant increase in the percentage of opioid prescriptions with co-prescribed naloxone after the first alert version.
• Further significant increase in naloxone co-prescribing rates after implementing the second (active choice) alert version.
• Substantial decrease in overall alert volumes during the study period.
• Educational campaign likely contributed to observed improvements in naloxone prescribing.

Conclusions:

• Choice architecture, particularly active choice design, is an effective strategy for improving CDS alert outcomes.
• CDS alert design modifications can enhance medication safety (naloxone prescribing) and reduce alert fatigue.
• Integrating behavioral design principles into EHR alerts can optimize clinical workflows and patient safety.