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Evaluating the Impact of Auto-Calculation Settings on Opioid Prescribing at an Academic Medical Center.
Jt Comm J Qual Patient Saf. 2019 06; 45(6):416-422.JC

Abstract

BACKGROUND

Overprescribing of opioids is a key contributor to the opioid epidemic, which has led to a substantial increase in overdose deaths. The purpose of this study was to evaluate the discontinuation of a dispense quantity automatic calculation function on prescribing of as needed (PRN) opioids.

METHODS

During the implementation of a new electronic health record (EHR), Vanderbilt University Medical Center discontinued functionality that autocalculated the maximum needed dispense quantity for PRN outpatient prescription opioids. This study analyzed prescribing trends for immediate-release hydrocodone- and oxycodone-containing prescriptions 90 days before and after implementation of the new EHR.

RESULTS

A total of 21,323 prescriptions were analyzed in the preintervention group and 22,730 prescriptions in the postintervention group. Discontinuing the autocalculation functionality resulted in a mean decrease of 1.4 dispense units per prescription (58.5 vs. 57.1; p = 0.006) across all patient care areas. The most significant finding was a 10.5% relative decrease in dispense units from inpatient discharge prescriptions (37.2 vs. 33.3; p < 0.001). In the new EHR, PRN oxycodone products defaulted to a dispense quantity of 30, which resulted in a 142.0% (10.0% vs. 24.2%; p < 0.001) increase in oxycodone prescriptions ordered for 30 dispense units but was a net reduction in the doses dispensed per oxycodone prescription.

CONCLUSION

This study suggests that removing the autocalculation functionality reduced the number of opioid units ordered. In addition, using a default dispense quantity for PRN opioid prescriptions may decrease the number of opioid dispense units per prescription.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

30935884

Citation

Crothers, Garrett, et al. "Evaluating the Impact of Auto-Calculation Settings On Opioid Prescribing at an Academic Medical Center." Joint Commission Journal On Quality and Patient Safety, vol. 45, no. 6, 2019, pp. 416-422.
Crothers G, Edwards DA, Ehrenfeld JM, et al. Evaluating the Impact of Auto-Calculation Settings on Opioid Prescribing at an Academic Medical Center. Jt Comm J Qual Patient Saf. 2019;45(6):416-422.
Crothers, G., Edwards, D. A., Ehrenfeld, J. M., Woo, E., McCluggage, L., & Lobo, B. (2019). Evaluating the Impact of Auto-Calculation Settings on Opioid Prescribing at an Academic Medical Center. Joint Commission Journal On Quality and Patient Safety, 45(6), 416-422. https://doi.org/10.1016/j.jcjq.2019.02.010
Crothers G, et al. Evaluating the Impact of Auto-Calculation Settings On Opioid Prescribing at an Academic Medical Center. Jt Comm J Qual Patient Saf. 2019;45(6):416-422. PubMed PMID: 30935884.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluating the Impact of Auto-Calculation Settings on Opioid Prescribing at an Academic Medical Center. AU - Crothers,Garrett, AU - Edwards,David A, AU - Ehrenfeld,Jesse M, AU - Woo,Edward, AU - McCluggage,Lauren, AU - Lobo,Bob, Y1 - 2019/03/29/ PY - 2018/08/31/received PY - 2019/02/20/revised PY - 2019/02/21/accepted PY - 2019/4/3/pubmed PY - 2020/9/22/medline PY - 2019/4/3/entrez SP - 416 EP - 422 JF - Joint Commission journal on quality and patient safety JO - Jt Comm J Qual Patient Saf VL - 45 IS - 6 N2 - BACKGROUND: Overprescribing of opioids is a key contributor to the opioid epidemic, which has led to a substantial increase in overdose deaths. The purpose of this study was to evaluate the discontinuation of a dispense quantity automatic calculation function on prescribing of as needed (PRN) opioids. METHODS: During the implementation of a new electronic health record (EHR), Vanderbilt University Medical Center discontinued functionality that autocalculated the maximum needed dispense quantity for PRN outpatient prescription opioids. This study analyzed prescribing trends for immediate-release hydrocodone- and oxycodone-containing prescriptions 90 days before and after implementation of the new EHR. RESULTS: A total of 21,323 prescriptions were analyzed in the preintervention group and 22,730 prescriptions in the postintervention group. Discontinuing the autocalculation functionality resulted in a mean decrease of 1.4 dispense units per prescription (58.5 vs. 57.1; p = 0.006) across all patient care areas. The most significant finding was a 10.5% relative decrease in dispense units from inpatient discharge prescriptions (37.2 vs. 33.3; p < 0.001). In the new EHR, PRN oxycodone products defaulted to a dispense quantity of 30, which resulted in a 142.0% (10.0% vs. 24.2%; p < 0.001) increase in oxycodone prescriptions ordered for 30 dispense units but was a net reduction in the doses dispensed per oxycodone prescription. CONCLUSION: This study suggests that removing the autocalculation functionality reduced the number of opioid units ordered. In addition, using a default dispense quantity for PRN opioid prescriptions may decrease the number of opioid dispense units per prescription. SN - 1938-131X UR - https://www.unboundmedicine.com/medline/citation/30935884/Evaluating_the_Impact_of_Auto_Calculation_Settings_on_Opioid_Prescribing_at_an_Academic_Medical_Center_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-7250(18)30435-5 DB - PRIME DP - Unbound Medicine ER -