How 1 Small Change Reduced Post-Op Opioids at 3 Hospitals

^{Image has been altered. Courtesy of Flickr user Cindy Shebley.}

All it took was one small change in an electronic health record (EHR) system to significantly decrease the number of opioids prescribed for the most common surgeries, according to a study published in JAMA Surgery.

Researchers from the Yale School of Medicine lowered the default number for post-op opioids in the EHR used by the Yale New Haven Health System from 30 pills to 12 and then tracked how many pills were prescribed for the three months before and after the change.

>> READ: Rise of the Anti-Opioid Algorithm

Researchers limited their analysis to the 10 most common procedures and tracked roughly 1,500 procedures at the three hospitals that used the system before and after the change. They found after lowering the default, the number of opioids prescribed declined by more than 15 percent. Across the entire system, that adds up to the equivalent of 25,000 fewer pills of 5mg oxycodone prescribed.

Researchers chose 12 pills based on previous research suggesting that between 10 and 15 pills is generally sufficient for the 10 most common procedures. And in fact, there was no significant increase in the number of refill requests. This is consistent with previous research suggesting that between 67 and 92 percent of patients end up with unused opioid pills after a surgery.

David Juurlink, Ph.D., M.D., a professor at the University of Toronto who’s interested in drug safety research, says the danger in overprescribing is twofold. First, it leaves open the possibility that it will fall into the wrong hands, like those of a curious teen. And second, the longer someone is on opioids, the higher the probability they’ll become dependent.

A recent study, published in the Annals of Emergency Medicine, looked at the relationship between how many opioids are prescribed after an ankle sprain and whether patients struggled with prolonged use. According to the findings, 6.2 percent of patients who were prescribed more than 30 Percocet pills after the sprain struggled with prolonged use, versus 1.2 percent for those prescribed fewer than 10 pills.

“We’ve lost our respect for the side effects of opioids,” Juurlink said.

In the study, the researchers point out that the default change — a programmatic change to a computer system — was a virtually cost-free way to change the doctors’ behavior and effect a change on the number of unnecessary pills being prescribed.

Before the change, doctors prescribed 30 pills 39 percent of the time, and 12 pills 2.1 percent. After the change, doctors prescribed 30 pills 12.9 percent of the time and 12 pills 24.5 percent. In addition, the number of times doctors prescribed 20 pills went up from 12.2 to 19.6 percent of the time, which would indicate that 12 served as an anchor number, and even when doctors felt it was too low, they tended to round up to 20 rather than 30.

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