Implementation of Electronic Medical Record Interventions to Maximize Opioid Disposal after Surgery in Routine Clinical Practice.

Abstract

Background: Despite guideline-directed opioid prescribing after operation, many patients retain excess opioids. Leftover pills increase the risk for misuse, diversion, and dependency. It is unclear whether interventions applied in routine clinical practice can increase excess opioid disposal rate.

Study design: All adult patients at our institution with postoperative opioid prescriptions were identified in general surgery, otolaryngology, plastic surgery, neurosurgery, urology, and transplant surgery. Disposal rates for 453 preintervention patients (operation between March 1, 2023, and June 30, 2023) were compared with 545 intervention patients (operation between October 1, 2023, and January 31, 2024). Pre- and postintervention patients were called 1 to 3 months after operation and asked about excess opioids. Interventions include (1) opioid disposal information sheets provided after operation; (2) opioid disposal reminder delivered via patient portal in electronic medical record (EMR); and (3) best practice alert triggered in EMR at postoperative visit reminded providers to discuss opioid disposal.

Results: Opioid disposal outcomes were obtained from 70% (699 of 998) of patients. Fifty-four percent (375 of 699) had excess opioids. The percentage of patients disposing of their excess opioids increased from 30% (39 of 130) preintervention to 83% (204 of 245) postintervention (p < 0.00001). Forty-seven percent (247 of 545) of postintervention patients had discussions with their providers after a best practice alert fired at their postoperative visits. Patients who had a provider discussion were more likely to dispose of excess opioids than those who only received an information sheet and patient portal reminder (92% vs 70%, p < 0.00001).

Conclusions: Interventions easily incorporated into the EMR as part of routine clinical practice can markedly increase excess opioid disposal rates after operation. When information on opioid disposal and patient portal reminders are combined with disposal discussions with providers at the postoperative visit, opioid disposal rate of >90% can be achieved.