Answered on August 28, 2024
De-selecting automated opioid orders does reduce postpartum opioid use after vaginal deliveries.
A quality improvement study evaluated the impact of de-selecting an automated order for oxycodone-acetaminophen from an electronic medical record (EMR) order set for postpartum vaginal deliveries. The study compared opioid use before and after the EMR change. The results showed a significant reduction in the proportion of patients who received opioids postpartum, from 32.9% pre-intervention to 12.5% post-intervention, representing a 62% decrease (p < 0.001).[1]
Additionally, there was no significant difference in the median total morphine milligram equivalents (MME) consumed by those who did receive opioids, nor was there a significant difference in discharge opioid prescriptions between the two groups.[1] This suggests that removing automated opioid orders from EMR order sets can effectively reduce inpatient opioid exposure without adversely affecting pain management or discharge prescribing practices.
These findings underscore the influence of EMR order sets on prescribing behaviors and support the consideration of removing automated opioid orders to mitigate opioid exposure in postpartum patients.

1.
The Effect of an Automated Order on Postpartum Opioid Use After Uncomplicated Vaginal Deliveries.

Alley A, Cowles S, Rangan P, Gerkin R, Mahnert N.

Journal of Women's Health (2002). 2022;31(6):842-847. doi:10.1089/jwh.2021.0378.

To address the opioid epidemic, physicians are encouraged to identify means of reducing patient opioid exposure. Electronic medical records (EMRs) often include default order sets with automated orders for opioid medications, which may influence how much opioids physicians prescribe. We sought to evaluate the impact of de-selecting an automated order for oxycodone-acetaminophen from an EMR order set for postpartum vaginal deliveries on inpatient opioid exposure by comparing the proportion of patients who received an opioid after an uncomplicated vaginal delivery before and after the EMR change. As secondary outcomes, the impact on average total morphine milligram equivalents (MMEs) and discharge opioid prescriptions was investigated. A quality improvement study was conducted through retrospective chart review of uncomplicated vaginal deliveries for the four quarters before and after the EMR order set change occurred. The total proportion of patients who received an opioid in the postpartum period was then determined for the preexposure and postexposure groups. The total average MME consumed for patients who received an opioid in each group was determined and the total proportion of patients who received an opioid prescription at discharge was compared. A total of 5826 records of uncomplicated vaginal deliveries met the criteria for analysis. In the preintervention group, 32.9% of patients received an opioid postpartum, compared to 12.5% of patients in the postintervention group, representing a decrease of 62.0% ( < 0.001). Of those who received opioids, the preintervention mean total opioid consumption was 28.4 MME (±27.6) compared to 33.6 MME (±46.4) postintervention, and there was no significant difference in median total opioid consumption: 22.5 MME (interquartile range [IQR]: 7.5-47.5) preintervention compared with 20.8 MME (

Iqr: 7.5-45.0) postintervention ( = 0.902). No significant difference was found with discharge opioid prescriptions between the two groups. Order sets within EMR systems appear to have a significant influence on physician prescribing behaviors and removing these automated orders for opioids should be considered.