Changes in Provider Prescribing Patterns After Implementation of an Emergency Department Prescription Opioid Policy

• Published in: The Journal of emergency medicine 2017-04, Vol.52 (4), p.538-546
• Main Authors: Osborn, Scott R., MD, Yu, Julianna, MD, Williams, Barbara, PhD, Vasilyadis, Maria, MD, Blackmore, C. Craig, MD, MPH
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics, Opioid - therapeutic use; chronic pain; Codeine - therapeutic use; Drug Prescriptions - standards; Drug Prescriptions - statistics & numerical data; Emergency; Emergency Service, Hospital - organization & administration; Emergency Service, Hospital - statistics & numerical data; Female; Humans; Hydrocodone - therapeutic use; Hydromorphone - therapeutic use; Male; Middle Aged; narcotic; opioid; Organizational Policy; overdose; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - statistics & numerical data; prescription policy; Quality Improvement; United States
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2016.07.120

Abstract Background Prescription opioid-associated abuse and overdose is a significant cause of morbidity and mortality in the United States. Opioid prescriptions generated from emergency departments (EDs) nationwide have increased dramatically over the past 20 years, and opioid-related overdose deaths have become an epidemic, according to the Centers for Disease Control and Prevention. Objective Our aim was to determine the effectiveness of implementing a prescription policy for opioids on overall opioid prescribing patterns in a hospital ED. Methods The ED provider group of an academic, non-university–affiliated urban hospital with 23,000 annual patient visits agreed to opioid prescribing guidelines for chronic pain with the goal of limiting prescriptions that may be used for abuse or diversion. These guidelines were instituted in the ED through collaborative staff meetings and educational and training sessions. We used the electronic medical record to analyze the number and type of opioid discharge prescriptions during the study period from 2006–2014, before and after the prescribing guidelines were instituted in the ED. Results The number of patients discharged with a prescription for opioids decreased 39.6% (25.7% to 15.6%; absolute decrease 10.2%; 95% confidence interval [CI] 9.6–10.7; p