Elimination of the Opioid Sliding Scale Is Associated with Improved Opioid Stewardship Metrics

Hospitals traditionally use an opioid sliding scale, prescribing lower doses for pain scores of 4-6 and higher doses for pain score 7-10. The authors hypothesized that elimination of the opioid sliding scale and implementation of additional electronic health record (EHR) "nudges" could improve adoption of best practices and improve opioid stewardship metrics.

Focus groups with key stakeholders were employed to design, implement, and evaluate the intervention. The intervention used the EHR to eliminate the conventional opioid sliding scale with a novel order set favoring non-opioids and setting a new single threshold for opioid administration (pain score of 5-10). Baseline and postintervention data for inpatients with hospital stay ≤ 30 days were extracted from the medical record. Subanalysis was performed for patients undergoing at least one operative procedure. Mean morphine milligram equivalents (MME) administered and prescribed at discharge were compared using analysis of variance.

This multicenter study included 60,464 inpatients for the baseline and postintervention time periods. Interventions were associated with a 31.4% (95% confidence interval [CI] 26.3%-36.5%) reduction in the mean inpatient MME administered and a 12.4% (95% CI 6.7%-18.3%) reduction in the mean MME prescribed. For the subset of patients who underwent an operative procedure (22.6% of the cohort), there was a 37.3% (95% CI 31.0%-43.7%) reduction in the mean inpatient MME administered and 12.1% (95% CI 8.3%-15.9%) reduction in MME prescribed.

Elimination of the conventional opioid sliding scale and other EHR "nudges" have the potential to reduce opioids administered. These findings support safe pain management practices and demonstrate a scalable model for health system opioid stewardship.