A study found that transparency regarding EHR interventions that change default opioid dosing settings could help improve clinician support for such interventions. The study also found that clinicians should not automatically trust default settings and that it is important to understand how the settings were developed. Finally, EHRs should require clinicians to justify overriding a new default dosing setting for opioid prescriptions.
A qualitative study published in JAMA Network Open found that transparency regarding EHR interventions that change default dosing settings for opioids could help improve clinician support for such interventions.
The study, which was conducted at a tertiary medical center, lowered the default number of opioid doses in an EHR system for adolescents and young adults undergoing tonsillectomy to an evidence-based level.
One-year post-implementation, the researchers conducted semistructured interviews with otolaryngology physicians who had cared for adolescents and young adults undergoing tonsillectomy.
None of the 16 participants knew that the default number of doses had decreased from 30 to 12. However, 10 participants wrote one or more prescriptions with 12 doses after this change, and some of these providers mistakenly believed that they had not done so.
Some participants in the study credited the power of default dosing settings to the fact that it was easier to comply with these settings rather than take the time to override them. Others indicated that they trusted that the EHR dosing settings signaled the appropriate behavior.
Notably, some participants thought the normative power of default dosing settings would be the greatest for inexperienced clinicians.
The study’s authors concluded that transparency regarding EHR interventions that change default dosing settings for opioids could help improve clinician support for such interventions. Also, they stated that default settings should not be blindly trusted by physicians and that it is crucial to comprehend how the settings were created. Furthermore, they recommended that EHRs mandate doctors to justify altering the new default dose level for opioid prescriptions.
Limitations
The study’s authors noted two limitations to their study. First, the transferability of findings is unclear, as the study assessed one surgical population at a single institution. However, most participants were confident that other surgical populations and institutions could use evidence-based default dosing settings for opioids.
Second, the researchers were unable to interview only participants who were exposed both to the original and updated order set, owing to the limited number of otolaryngologists at their institution. However, nearly all eligible otolaryngologists participated, increasing confidence in the validity of the findings.
Implications
The findings of this study suggest that transparency regarding EHR interventions that change default dosing settings for opioids could help improve clinician support for such interventions. Additionally, clinicians should not automatically trust default settings, and it is important to understand how the settings were developed. Finally, EHRs should require clinicians to justify overriding a new default dosing setting for opioid prescriptions.
