Effect of Default Order Standardization on Opioid Prescribing Patterns

Background: Opioid misuse, overprescribing, dependency, and overdose remains a significant concern in the United States. A quality improvement study was conducted at the University of Illinois Hospital & Health Sciences System to determine the effect of standardizing the default orders for hydrocodone-acetaminophen products implemented on June 22, 2016. Methods: Prior to the intervention, default orders had variable dose tablet numbers (1 or 2) and dosing frequencies (every 4 or 6 hours), and no default dispense quantity. Defaults were modified to 1 tablet every 6 hours as needed for pain and dispense quantities of 3 and 5 days' supply were added. Number of tablets per order, dosing frequency, and days' supply prescribed between January 1, 2016, and June 21, 2016, were compared to those placed between June 22, 2016, and December 31, 2016. Opioid doses were converted into morphine milligram equivalents (MME). Analyses were performed to determine the effect of the intervention on daily opioid dose and number of days' supply prescribed. Results: 22,052 orders were included in this study. Following the intervention, the number of tablets prescribed was reduced by an average of 19,832 tablets per month. Every 6 hours dosing (as opposed to every 4 hours) increased by 21.52 percentage points. Prescriptions with >= 50 MME/day dropped by 5.8 percentage points, and > 3 days' supply decreased by 2.54 percentage points. Linear regression demonstrated an increase in opioid prescriptions with daily < 50 MME (odds ratio [OR] = 1.72, p < 0.001) and <= 3 days' supply (OR = 1.27, p < 0.001). Conclusion: Default electronic health record settings strongly influence prescribing patterns.