Kleinbart Emily, Tornberg Haley, Rivera-Pintado Christopher, Hunter Krystal, Kleiner Matthew T, Miller Lawrence S, Pollard Mark, Fedorka Catherine J
Department of Orthopaedic Surgery, Cooper University Hospital, Camden, NJ, USA.
Cooper Medical School of Rowan University, Camden, NJ, USA.
JSES Rev Rep Tech. 2024 Feb 15;4(2):208-212. doi: 10.1016/j.xrrt.2024.01.004. eCollection 2024 May.
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.
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.
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 ( < .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 ( < .001) and for 3 ( < .001) of the 4 orthopedic surgeons included in this study.
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.
鉴于当前的阿片类药物流行情况，严格监管用于疼痛管理的麻醉药物处方至关重要。通过医院电子病历平台使用电子处方（e-scripts）可使医生开具较小剂量的阿片类药物处方，这可能会限制患者可获得的镇痛药总量，并降低药物滥用的可能性。本研究的目的是确定电子处方的实施如何改变肩部手术后开具的阿片类药物数量。
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岁及以上患者的数据。比较了三个队列在术后90天内开具的阿片类药物的吗啡当量（MMEs）总量：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电子处方实施前，以及2019年电子处方实施后（电子处方实施后）。任何术前开具阿片类药物、由非骨科医生开具阿片类药物、在疼痛管理医生护理下或同时进行非肩部手术的患者均被排除在本研究之外。
本研究共纳入1857名受试者；新泽西州阿片类药物法实施前796名，新泽西州阿片类药物法实施后、电子处方实施前520名，电子处方实施后541名。2019年7月1日实施电子处方后，开具的MMEs总量显著下降（<.001），从实施前的中位数90 MME（四分位间距65，65 - 130）降至实施后的中位数45 MME（四分位间距45，45 - 90）MME。此外，所有手术开具的阿片类药物数量均有统计学显著下降（<.001），本研究纳入的4名骨科医生中有3名开具的阿片类药物数量下降（<.001）。
我们的研究表明，在2019年7月实施电子处方后的术后期间，总体上、所有肩部手术以及我们机构的大多数提供者开具的MMEs总量均显著减少。电子处方是一种有价值的工具，与国家、机构、提供者和患者层面的教育及意识提升相结合，以应对阿片类药物流行。
