Changing the default option in electronic medical records reduced postoperative opioid prescriptions after cardiac surgery

Peer Comparison or Guideline-Based Feedback and Postsurgery Opioid Prescriptions

“…Prior efforts to change postoperative prescribing with behavioral interventions have used pretest-posttest designs and have shown reductions in the number of tablets prescribed. 15 , 35 , 36 , 37 , 38 , 39 The present work is consistent with trials testing clinician feedback interventions on opioid prescribing in emergency department, primary care, and urgent care sites, 14 , 17 , 40 , 41 , 42 , 43 although 2 other trials examining clinician feedback on concurrent prescribing of opioids and benzodiazepines did not show reductions 40 , 44 in concurrent prescribing. The finding that both the peer-based descriptive norm and guideline-based injunctive norm treatment conditions were equally effective contributes to an ongoing debate from the broader norms literature about which type of norm—descriptive or injunctive—is more likely to exert an effect in a fast-paced environment in which there is a great deal of cognitive depletion.…”

“…To our knowledge, this is the first study to examine the effect of feedback interventions on postoperative opioid prescribing using a randomized design, and one of the first studies to compare the effectiveness of 2 types of social norms on clinician behavior—peer-comparison descriptive norms and guideline-based injunctive norms. Prior efforts to change postoperative prescribing with behavioral interventions have used pretest-posttest designs and have shown reductions in the number of tablets prescribed . The present work is consistent with trials testing clinician feedback interventions on opioid prescribing in emergency department, primary care, and urgent care sites, although 2 other trials examining clinician feedback on concurrent prescribing of opioids and benzodiazepines did not show reductions in concurrent prescribing.…”

“…15,[35][36][37][38][39] The present work is consistent with trials testing clinician feedback interventions on opioid prescribing in emergency department, primary care, and urgent care sites,14,17,[40][41][42][43] although 2 other trials examining clinician feedback on concurrent prescribing of opioids and benzodiazepines did not show reductions40,44 in concurrent prescribing. The finding JAMA Health Forum | Original Investigation…”

Commentary: A missing link between good theory and suspect prescription practice

“… 7 In response, systems-level interventions are needed to translate phase-of-care reductions in opioid use into prescriber practices. It is in this context that the study by Einarsson and colleagues 8 provides what at first glance seems like an elegantly simple solution to a problem of growing complexity. The authors describe the results of a before–after study involving modification of the default number of pills prescribed at discharge in their electronic medical record.…”

Commentary: Saying whoa to the woe of heart surgery

“…As we have become increasingly aware of the threat created by opioid medications administered following cardiac surgery, programs have pursued various alternate methods of analgesia and practices aimed at reducing opioid use. In their descriptive paper, “Changing the Default Option in the Electronic Medical Record Reduced Postoperative Opioid Prescriptions After Cardiac Surgery,” Einarsson and colleagues 1 demonstrate the significance of a simple measure impacting prescription dosing and as a consequence, patient exposure. Certainly, it is a mechanism that is easily reproducible and should be enacted by us all.…”