Reduction in Opioid Prescribing After Removal of Electronic Health Record Defaults Among Emergency Department...

Introduction  Opioid prescription reduction is a high-priority quality improvement area in the emergency department (ED) with significant opportunities for harm reduction. While electronic health records (EHR) default dispense quantities have been used to help practitioners become more efficient, automated prescription quantities may influence prescribers to provide more than what they would otherwise deem necessary. We sought to evaluate the prescribing behavior of residents, advanced practice providers (APPs), and attending physicians after the removal of the default dispense quantity of the most prescribed opioid in the ED.  Methods  This is a single-center retrospective pre-post observational study in the ED of the four months before and the four months after removing the default dispense quantity of 20 tablets of oxycodone/acetaminophen per prescription. We compared the changes in prescribing patterns of emergency medicine (EM) attendings, EM APPs, EM residents, surgical attendings, surgical residents, and surgical APPs.  Results  During the study period, there were a total of 2,468 prescriptions for oxycodone/acetaminophen, resulting in 41,612 tablets prescribed. There were 1,314 prescriptions for oxycodone/acetaminophen before and 1,154 prescriptions written after the removal of the default dispense quantity. The average number of tablets per prescription was reduced from 18.16 to 15.35 after the removal of the default dispense quantity. There was no significant difference in the number of prescriptions written before and after the intervention in terms of patient age, gender, race, Emergency Severity Index (ESI) level, or department of the prescriber. An overall 15% reduction in the number of tablets of oxycodone/acetaminophen prescribed was observed. This reduction was significant among EM attendings, EM residents, EM APPs, and surgical attendings. There was no significant change among surgical residents and surgical APPs.  Conclusion  Removing the default dispense quantity was associated with a reduction in the amount of oxycodone/acetaminophen prescribed in most but not all categories of prescribers. While lower default quantities have reduced opioid prescription quantities, a default dispense quantity of 20 tablets may lead to overprescribing. As practice patterns and recommended guidelines change, default dispense quantities should periodically be evaluated for unintended influence on residents, APPs, and attendings' behavior.