Association between electronic medical record implementation of default opioid prescription quantities and prescribing behavior in two emergency departments

Larger quantities of opioid tablets for initial prescriptions are associated with transition to continued use.Default options, or conditions that are set in place unless an alternative is actively chosen, have been shown to influence behavior in many contexts, including increasing the rates of prescribing generic versus brand-name drugs to over 98% in primary care. Leveraging default options in electronic medical record (EMR) prescribing orders thus represents a promising approach to guide clinicians towards prescribing smaller quantities of opioid tablets, thus reducing continued use, misuse, and diversion.

In 2015, the emergency departments (EDs) of the Hospital of the University of Pennsylvania (HUP, annual volume 68,000) and Penn Presbyterian Medical Center (PMC, annual volume 41,000) adopted a new EMR (Epic, Verona, WI) to replace a homegrown EMR (EMTRAC). EMTRAC required the clinician to enter the number of tablets for opioid prescriptions. Since the implementation of the new EMR, when a clinician types in an ED discharge opioid prescription order, a preference list appears with a default quantity of 10 tablets displayed first. The clinician can “opt out” by selecting a quantity of 20 tablets, which is displayed second, by modifying either of these orders, or by clicking on “Database Lookup,” where a new health system default of 28 tabs is displayed, as well as manual entry options. We evaluated the effect on prescribing behavior associated with the implementation of an EMR opioid default supply quantity for our most common opioid discharge prescription in two EDs.

National Institute of Child Health and Human Development (NICHD)
National Institute on Aging (NIA)
National Institute on Drug Abuse (NIDA)