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Influence of Default Order Sentence Standardization on the Prescribing Patterns of Hydrocodone-Acetaminophen Combination Products
Andrew Mudreac, BS; Adam Bursua, PharmD, BCPS; Laura Koppen, PharmD; Connie Larson, PharmD; Radhika Sreedhar MD, MS
Opioid misuse, dependency, and overdose is currently a significant concern in the United States. In June 2016, pre-built order sentences details for solid oral hydrocodone-acetaminophen products in Cerner, the electronic medical record (EMR) system used at University of Illinois at Chicago (UIC), were updated and standardized to maximize safety of dosing regimens and promote adherence to the CDC's opioid prescribing guidelines. The purpose of this study is to evaluate the impact of an EMR default order sentence change on the prescribing patterns for hydrocodone-acetaminophen combination products.
We conducted a retrospective review of prescription data from the UIC Cerner EMR system. The change to the pre-built order sentences was implemented on June 22, 2016. The pre-intervention group was defined as all outpatient prescription orders for solid oral hydrocodone-acetaminophen combination products placed between January 1, 2016 - June 21, 2016, while the post-intervention group included all prescription orders from June 23, 2016 - December 31, 2016. The number of tablets prescribed, days supply prescribed, and dosing frequency prescribed were compared across groups to determine if the order sentence changes impacted prescribing habits. IRB approval was obtained for this project. Data was obtained from a Cerner EMR report. We used a Chi-square test to determine if there is a significant difference between pre- and post-intervention groups in the following prescription parameters: total tablets dispensed, number of tablets (one versus two), day supply (three versus five days), and frequency (q4 versus q6 hours).
The total number hydrocodone-acetaminophen tablets prescribed in the post-intervention period relative to pre-intervention was reduced by 21,099 tablets. The mean number of tablets per patient pre-intervention was 55.14 (SD=43.97) while the mean number of post intervention tablets was 51.8 (SD=43.77) (p<.0001, 95% CI [2.18-4.50]). The prescribed 5 day supply decreased by 3.2% (p<.0001, Cramer's V=0.044). The frequency of dosing Q6h compared to Q4h was increased by 24% (p<0.0001, Cramer's V=.272).
Prescribing patterns are strongly influenced by default EMR settings. By altering pre-built prescription order sentences for solid oral hydrocodone-acetaminophen, the number of tablets prescribed, day supply, frequency of dosing, and total number of hydrocodone-acetaminophen combination tablets dispensed was drastically reduced.
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