JTCVS Open (Dec 2021)
Changing the default option in electronic medical records reduced postoperative opioid prescriptions after cardiac surgeryCentral MessagePerspective
Abstract
Objective: Overprescribing of opioids has contributed to the opioid epidemic. Electronic medical records systems can auto-populate a default number of opioid pills that are prescribed at time of discharge. The aim of this study was to examine the association between lowered default pill counts with changed prescribing practices after cardiac surgery. Methods: On May 18, 2017, the default number of pills prescribers see in electronic medical records in the Yale New Haven Health System was lowered from 30 to 12. Patients undergoing coronary artery grafts, valve surgeries, and thoracic aortic aneurysm surgeries were included in this study. Data were gathered and stratified into 2 groups: 1 year before and 1 year following the default change. The amount of opioid prescribed was compared between the 2 groups. Results: A total of 1741 patient charts were reviewed, 832 before the change and 909 after the change. Significant changes were seen in prescribing practices, where the average amount of opioid prescribed was about 25% lower after the change. This amounted to about 15 fewer pills of 5 mg morphine for each patient. A linear regression model adjusting for other factors determined a prescribing difference of 75.2 morphine milligram equivalents per prescription (P < .01). In addition, a significant decrease in opioids prescribed was found for each type of procedure. Conclusions: Lowering the default opioid pill count in electronic medical record systems is a simple intervention that may modify prescribing behavior to promote judicious prescribing of opioids after cardiac surgery.
