Adherence to opioid prescribing protocols after operations remains challenging despite
published guidelines. Integration of these guidelines with the electronic health record
could potentially improve their adoption. We hypothesize that implementing an electronic
health record order set containing prepopulated tablet quantities tailored to surgical
procedures based on published guidelines will decrease postoperative opioid prescription.
We conducted a 12-month prepost intervention study on adult patients who underwent
appendectomy, cholecystectomy, inguinal or umbilical hernia repair, thyroidectomy,
or parathyroidectomy at a single institution. An electronic health record order set
was developed with prepopulated opioid tablet quantities reflecting the upper limit
of published recommendations. The primary endpoint was change in morphine milligram
equivalent prescribed postintervention and was analyzed using linear regression adjusting
for age, race, procedure, and prescriber training level. Secondary endpoints were
emergency department visits for pain-related issues and opioid refill rates.
We identified 524 patients (mean age = 53, 51% male) in our baseline cohort and 433
patients (mean age = 52, 58% male) in our postintervention group. The mean morphine
milligram equivalent prescribed was 62.6 and 50.4 for the preintervention and postintervention
cohorts, respectively (P = .049). Thyroidectomies and parathyroidectomies achieved the largest decrease after
intervention, which decreased to 42.6 morphine milligram equivalent from 79.7 morphine
milligram equivalent preintervention (P < .001). Refill rate was 1.6% postintervention compared to 3.1% preintervention (P = .20), and emergency department visit for pain control rate was 0.2% post intervention
and 2.5% preintervention (P = .005).
An electronic health record tailored order set based on prescription guidelines is
a safe, effective, and scalable intervention for decreasing opioid prescriptions after