Impact of an Electronic Health Record Pain Medication Prescribing Tool on Opioid Prescriptions for Postoperative Pain in Hand, Orthopedic, Plastic, and Spine Surgery Across a Health Care System

被引:3
|
作者
Kearney, Aaron M. [1 ]
Kalainov, David M. [2 ,3 ,5 ]
Zumpf, Katelyn B. [4 ]
Mehta, Manish [2 ]
Bai, Jennifer [1 ]
Petito, Lucia C. [4 ]
机构
[1] Northwestern Univ, Div Plast Surg, Chicago, IL USA
[2] Northwestern Univ, Dept Orthopaed Surg, Chicago, IL USA
[3] Northwestern Med Ctr Surg Hand, Chicago, IL USA
[4] Northwestern Univ, Dept Prevent Med, Chicago, IL USA
[5] Northwestern Med Ctr Surg Hand, 737 North Michigan Ave,Suite 700, Chicago, IL 60611 USA
来源
关键词
Key words Electronic clinical decision support; electronic health records; opioids; opioid prescribing; postoperative pain; REDUCTION; BEHAVIOR; SAFER;
D O I
10.1016/j.jhsa.2022.08.009
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Purpose We hypothesized that a pain management prescribing tool embedded in the electronic health record system of a multihospital health care system would decrease prescription opi-oids for postoperative pain by hand, orthopedic, plastic, and spine surgeons. Methods A prescribing tool for postoperative pain was designed for hand, orthopedic, plastic, and spine surgeons and implemented into electronic discharge order sets in a 10-hospital health care system. Stakeholders were educated on tool use in person and/or by email on 2 occasions. A dashboard was created to monitor opioid pill quantities and morphine milligram equivalents (MMEs) prescribed. Overall compliance with the suggested opioid amounts was assessed for 20 months after tool implementation. A subgroup of 6 hand surgeons, one of whom was instru-mental in designing the tool, were evaluated for MMEs prescribed, opioid refills, patient emergency room visits, and patient readmissions within 30 days after discharge. Comparisons in this subgroup were made from 12 months before to 15 months after tool implementation. Results The mean system-wide compliance with the suggested opioid pill quantities and MMEs prescribed in all 4 specialties improved by less than 5%. In the subgroup of hand surgeons, 5 of whom championed tool use, prescribed MMEs decreased by 10% during each of the 4 quarters before launching the tool and contracted an additional 26% in the first quarter after tool implementation. Opioid refills held steady at 5%, and there were no emergency room visits or readmissions within 30 days after discharge in this patient subgroup. Conclusions The prescribing tool had a negligible impact on system-wide compliance with suggested prescription opioid pill quantities and MMEs. In a small group of surgeons who championed the use of the tool, there was a significant and sustained decline in MMEs pre-scribed without adversely impacting patient refills, emergency room visits, or readmissions. Clinical relevance An electronic prescribing tool to assist surgeons in lowering opioid pre-scription pill quantities and MMEs may have a negligible impact on prescribing behavior in a multihospital health care system. (J Hand Surg Am. 2022;47(11):1035e1044. Copyright
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收藏
页码:1035 / 1044
页数:10
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