Narcotic prescribing practices in shoulder surgery before and after the institution of narcotic e-prescribing

Emily Kleinbart BA , Haley Tornberg BS , Christopher Rivera-Pintado MD , Krystal Hunter PhD , Matthew T. Kleiner MD , Lawrence S. Miller MD , Mark Pollard MD , Catherine J. Fedorka MD
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Abstract

Background

Given the current opioid epidemic, it is crucial to highly regulate the prescription of narcotic medications for pain management. The use of electronic prescriptions (e-scripts) through the hospital’s electronic medical record platform allows physicians to fill opioid prescriptions in smaller doses, potentially limiting the total quantity of analgesics patients have access to and decreasing the potential for substance misuse. The purpose of this study is to determine how the implementation of e-scripts changed the quantity of opioids prescribed following shoulder surgeries.

Methods

For this single-center retrospective study, data were extracted for all patients aged 18 years or more who received a shoulder procedure between January 2015 and December 2020. Total milligrams of morphine equivalents (MMEs) of opioids prescribed within the 90 days following surgery were compared between 3 cohorts: preimplementation of the 2017 New Jersey Opioid laws (Pre-NJ opioid laws), post-NJ Opioid Laws but pre-escripting, and postimplementation of e-scripting in 2019 (postescripting). Any patient prescribed preoperative opioids, prescribed opioids by nonorthopedic physicians, under the care of a pain management physician, or had a simultaneous nonshoulder procedure was excluded from this study.

Results

There were 1857 subjects included in this study; 796 pre-NJ opioid laws, 520 post-NJ opioid laws, pre-escripting, and 541 postescripting. Following implementation of e-scripting on July 1, 2019, there was a significant decrease in total MMEs prescribed (P < .001) from a median of 90 MME (interquartile range 65, 65-130) preimplementation to a median 45 MME (interquartile range 45, 45-90) MME postimplementation Additionally, there was a statistically significant decrease in opioids prescribed for all procedures (P < .001) and for 3 (P < .001) of the 4 orthopedic surgeons included in this study.

Conclusion

Our study demonstrated a significant reduction in total MMEs prescribed overall, for all shoulder surgeries, and for the majority of our institution’s providers in the postoperative period following the e-scripting implementation in July 2019. E-scripting is a valuable tool in conjunction with education and awareness on the national, institutional, provider, and patient levels to combat the opioid epidemic.

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麻醉药品电子处方制度实施前后肩部手术中的麻醉药品处方做法
背景鉴于目前阿片类药物的流行,高度规范用于疼痛治疗的麻醉药物处方至关重要。通过医院的电子病历平台使用电子处方(e-scripts),医生可以开出较小剂量的阿片类药物处方,从而有可能限制患者获得的镇痛药总量,减少药物滥用的可能性。本研究旨在确定电子病历的实施如何改变肩部手术后阿片类药物的处方量。方法在这项单中心回顾性研究中,提取了 2015 年 1 月至 2020 年 12 月期间接受肩部手术的所有 18 岁或以上患者的数据。对术后 90 天内开具的阿片类药物总毫克吗啡当量(MMEs)在 3 个队列之间进行了比较:2017 年新泽西州阿片类药物法实施前(新泽西州阿片类药物法实施前)、新泽西州阿片类药物法实施后但脚本化前以及 2019 年电子脚本化实施后(脚本化后)。任何在术前开具阿片类药物处方的患者、由非骨科医生开具阿片类药物处方的患者、由疼痛管理医生护理的患者或同时进行非肩部手术的患者均被排除在本研究之外。结果本研究共纳入 1857 名受试者;其中 796 名受试者在新泽西州阿片类药物法实施前接受治疗,520 名受试者在新泽西州阿片类药物法实施后接受治疗,541 名受试者在新泽西州阿片类药物法实施前接受治疗,541 名受试者在新泽西州阿片类药物法实施后接受治疗。在 2019 年 7 月 1 日实施电子脚本后,开出的 MME 总量显著减少(P < .001),从实施前的中位数 90 MME(四分位距为 65,65-130)减少到实施后的中位数 45 MME(四分位距为 45,45-90)。结论我们的研究表明,在 2019 年 7 月实施电子脚本后的术后阶段,总体而言,所有肩部手术以及本机构大多数医疗服务提供者开具的 MMEs 总量均显著减少。电子处方笺是一项非常有价值的工具,它与国家、机构、医疗机构和患者层面的教育和宣传相结合,可有效遏制阿片类药物的流行。
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