Guiding Opioid Prescribing Behavior in the Emergency Department: EMR-Based Interventions
Digital decision-making environments allow physicians to receive a "nudge" regarding opioid prescribing practices.
Implementation of an electronic medical record (EMR) default opioid prescription of 10 tablets of 5 mg oxycodone/325 mg acetaminophen (Oxy/APAP) at discharge from the emergency department (ED) may be associated with an increased percentage of prescriptions for 10 tablets, compared with having no default number, according to the results of a recent study published in the Journal of General Internal Medicine.
To evaluate the impact of an EMR intervention that provided a default prescription of 10 Oxy/APAP tablets, researchers evaluated weekly prescribing patterns for those tablets for 4 weeks before and 4 weeks after default implementation at 2 Pennsylvania EDs in 2015.1
The mean number of prescriptions for Oxy/APAP tablets per week was similar across the 2 EDs (P =.42) and decreased from 11.3 to 10 (P =.004) in one emergency department and from 12.6 to 10.9 in the other (P <.001).1
After default implementation, the percentage of prescriptions written for 10 tablets increased by 22.8% in both EDs. Moreover, after implementation, the percentage of prescriptions written for 20 tablets decreased by 6.7%, prescriptions written for 11 to 19 tablets decreased by 13.3%, and the number of prescriptions written for <10 tablets also decreased by 5%. The investigators noted that the decrease in prescriptions for <10 tablets suggested that, “future efforts to set default quantities should start with the lowest baseline prescription.”
In an editorial on improving healthcare delivery and behavior, change in EMR system default tablet prescription, along with other similar interventions, were described as “nudges.” Mitesh Patel, MD, MBA, and colleagues from the Penn Medicine Nudge Unit, suggested that, “as more health care decisions are made within digital environments where they can be witnessed and their context can easily be reshaped, nudging opportunities expand.”2
- Delgado MK, Shofer FS, Patel MS, et al. Association between electronic medical record implementation of default opioid prescription quantities and prescribing behavior in two emergency departments [published online January 16, 2018]. J Gen Intern Med. doi: 10.1007/s11606-017-4286-5
- Patel MS, Volpp KG, Asch DA. Nudge units to improve the delivery of health care. N Engl J Med. 2018;378(3):214-216.