Effect of Best Practice Alert (BPA) on Post-Discharge Opioid Prescribing After Minimally Invasive Hysterectomy: A Quality Improvement Study

Abstract

Purpose

The aim of this study was to describe the effectiveness of an electronic health record best practice alert (BPA) in decreasing gynecologic post-discharge opioid prescribing following benign minimally invasive hysterectomy.

Patients and Methods

The BPA triggered for opioid orders >15 tablets. Prescribers’ options included (1) decrease to 15 ≤ tablets; (2) remove the order/utilize a defaulted order set; or (3) override the alert.

Results

332 patients were included. The BPA triggered 29 times. The following actions were taken among 16 patients for whom the BPA triggered: “override the alert” (n=13); “cancel the alert” (n=2); and ‘remove the opioid order set’ (n=1). 12/16 patients had discharge prescriptions: one patient received 20 tablets; two received 10 tablets; and nine received 15 tablets. Top reasons for over prescribing included concerns for pain control and lack of alternatives.

Conclusion

Implementing a post-discharge opioid prescribing BPA aligned opioid prescribing following benign minimally invasive hysterectomy with guideline recommendations.

Keywords:

• hysterectomy
• opioid
• prescribing
• patient discharge
• practice patterns

Disclosure

Dr. Sawsan As-Sanie served as a consultant to Bayer Pharmaceuticals, Organon, Myovant-Sciences and Pfizer for research studies related to endometriosis, receives author royalties from UpToDate, and provided expert testimony, not relevant for any aspect of the submitted work. Dr. Brummett is a consultant for Alosa Health, Benter Foundation, Heron Therapeutics, Vertex Pharmaceuticals, and provides expert testimony, not relevant for any aspect of the submitted work. The authors report no other conflicts of interest in this work.