Lower Opioid Prescription EHR Defaults Linked to Prescribing Reduction

Decreasing the default number of doses in opioid prescriptions written in EHR systems was associated with a reduction in opioid prescribing among pediatric otolaryngology patients, according to a study published in JAMA Network Open.

In the nonrandomized clinical trial including 237 patients, researchers lowered the default number of doses in opioid prescriptions from 30 to 12 based on prospectively collected data on patient-reported opioid consumption.

Compared with the control group, the intervention was associated with a 46 percent increase in the proportion of opioid prescriptions with 12 doses.

In contrast, the researchers found that the intervention did not change opioid consumption, pain control, anxiety, or depression.

Prior studies found that implementing opioid prescribing guidelines based on patient-reported opioid consumption data decreased perioperative opioid prescribing without worsening patient-reported outcomes or increasing refills.

Similarly, implementing evidence-based default settings in the EHR for pediatric otolaryngology did not worsen most patient-reported outcomes. However, the study found an apparent worsening in sleep disturbance. The study authors noted that the clinical significance of this finding is uncertain, given that the magnitude of the change was small.

The researchers emphasized that while they did not announce the change in default EHR settings to otolaryngology clinicians, opioid prescribing changed, suggesting that default settings may have the ability to influence clinician behavior.

“Although this ability could be leveraged to improve outcomes, poorly set default settings could have the opposite effect,” the researchers wrote. “To avoid this possibility, default settings should ideally be based on patient-reported opioid consumption data.”

The authors pointed out that changing default settings in the EHR cannot eliminate excessive opioid prescribing alone, as suggested by incomplete adherence to the new defaults in the study. They indicated that incomplete adherence may have been due to inconsistent use of the tonsillectomy order set on the pediatric otolaryngology service.

Another reason may have been the lack of an announcement by the chief of pediatric otolaryngology that the new standard was to prescribe 12 opioid doses.

“The combination of such an announcement, coupled with reinforcement of the new standard via the default settings, could have resulted in even more significant reductions in opioid prescribing than observed in our study,” the study authors wrote.

The authors noted that the study has several limitations. Due to the limited sample size, the study could not detect small changes in results and did not correct for multiple comparisons.

Additionally, the researchers said that conclusions regarding patient-reported outcomes may have been different if clinician adherence to the new defaults had been more consistent.