Journal of Pain Research (Feb 2024)
Effect of Best Practice Alert (BPA) on Post-Discharge Opioid Prescribing After Minimally Invasive Hysterectomy: A Quality Improvement Study
Abstract
Alexandra Jankulov,1 Sawsan As-Sanie,2 Christopher Zimmerman,3 Jessica Virzi,4 Sudharsan Srinivasan,5 Hae Mi Choe,3 Chad M Brummett5,6 1Oakland University William Beaumont School of Medicine, Rochester Hills, MI, USA; 2Department of Obstetrics & Gynecology, University of Michigan Health System, Ann Arbor, MI, USA; 3Department of Health Information and Technology Services, University of Michigan Health System, Ann Arbor, MI, USA; 4Department of Precision Health, University of Michigan Health System, Ann Arbor, MI, USA; 5Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA; 6Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI, USACorrespondence: Chad M Brummett, Department of Anesthesiology, University of Michigan, 325 E Eisenhower Pkwy Ste 100, Ann Arbor, MI, 48108, USA, Tel +1 734-998-0455, Fax +1 734-936-6585, Email [email protected]: The aim of this study was to describe the effectiveness of an electronic health record best practice alert (BPA) in decreasing gynecologic post-discharge opioid prescribing following benign minimally invasive hysterectomy.Patients and Methods: The BPA triggered for opioid orders > 15 tablets. Prescribers’ options included (1) decrease to 15 ≤ tablets; (2) remove the order/utilize a defaulted order set; or (3) override the alert.Results: 332 patients were included. The BPA triggered 29 times. The following actions were taken among 16 patients for whom the BPA triggered: “override the alert” (n=13); “cancel the alert” (n=2); and ‘remove the opioid order set’ (n=1). 12/16 patients had discharge prescriptions: one patient received 20 tablets; two received 10 tablets; and nine received 15 tablets. Top reasons for over prescribing included concerns for pain control and lack of alternatives.Conclusion: Implementing a post-discharge opioid prescribing BPA aligned opioid prescribing following benign minimally invasive hysterectomy with guideline recommendations.Keywords: hysterectomy, opioid, prescribing, patient discharge, practice patterns
