Reducing daily dosing in opioid prescriptions in 11 safety net emergency departments

Dawi Shin, Hyung J. Cho, Daniel Alaiev, Surafel Tsega, Joseph Talledo, Milana Zaurova, Komal Chandra, Peter Alarcon, Mariely Garcia, Mona Krouss

Research output: Contribution to journalArticlepeer-review


Background: The United States continues to face a significant issue with opioid misuse, overprescribing, dependency, and overdose. Electronic health record (EHR) interventions have shown to be an effective tool to modify opioid prescribing behaviors. This quality improvement project describes an EHR intervention to reduce daily dosing in opioid prescriptions in 11 emergency departments (ED) across the largest safety net health system in the US. Measures: The primary outcome measure was the rates of oxycodone-acetaminophen 5–325 mg prescriptions exceeding 50 morphine milligram equivalents per day (MMED) pre- vs. post-intervention; and stratified by individual hospitals and provider type. Intervention: The defaults for dose and frequency were uniformly changed to ‘every 6 hours as needed’ and ‘1 tablet’, respectively, across 11 EDs. Outcomes: The percentage of prescriptions greater than or equal to 50 MMED decreased from 46.0% (1624 of 3530 prescriptions) to 1.6% (52 of 3165 prescriptions) (96.4% relative reduction; p < 0.001). All 11 hospitals had a significant reduction in prescriptions exceeding 50 MMED. Nurse practitioners had the highest relative reduction of prescriptions exceeding 50 MMED at 100% (p < 0.001), and the attendings/fellows had the lowest relative reduction at 95.6% (p < 0.001). Conclusions/Lessons Learned: Default nudges are a simple yet powerful intervention that can strongly influence opioid prescribing patterns.

Original languageEnglish
Pages (from-to)63-68
Number of pages6
JournalAmerican Journal of Emergency Medicine
StatePublished - Sep 2023


  • Default nudge
  • Opioid prescription
  • Outcome assessment
  • Patient safety
  • Quality improvement


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