Reducing Opioid Overprescribing During Transitions of Care in Postoperative Trauma Patients

Introduction: The CDC recommends prescribers limit opioid prescriptions to the lowest effective dose and quantity to reduce the risk of misuse. To promote judicious opioid prescribing, our health system implemented an oxycodone Our Practice Advisory (OPA). Oxycodone was chosen because it is the most common discharge opioid prescription. This study was designed to characterize oxycodone prescribing by the trauma service after the OPA implementation.


Methods: A quasi-experimental evaluation comparing oxycodone prescribing 7 months before (Jun-Dec 2023) and after (Jun-Dec 2024) implementation of an OPA was conducted at a large health system which includes 3 hospitals that provide trauma services. At the time of oxycodone prescribing, the OPA notified the prescribers if the patient had not received opioids in the preceding 24 hours of their inpatient stay. The OPA gave prescribers the option to discontinue the prescription (default action), reduce the quantity prescribed (recommended if the prescription was not discontinued), or to leave the prescription as it was originally entered prior to signing orders. The rate at which prescriptions were modified based upon the OPA was calculated and referred to as the action taken percentage (ATP). The primary outcome was the total morphine milligram equivalents (MME) prescribed by trauma providers in the pre- and post-groups; Wilcoxon rank-sum test was used. The post-group was further analyzed based on ATP.


Results: During the study period, the trauma service generated 59 and 58 oxycodone prescriptions in the pre- and post-groups, respectively. The ATP in the post-group was 19% (n=11; 5 discontinued, 6 reduced quantity). Total MME was 77.2 (standard deviation 22.8) versus 60.1 (40.3), respectively (p=0.003). In the post-group, total MME was 66.4 (40.5) when the OPA was declined but 33.4 (26.9) when action was taken (p=0.007). Quantity prescribed was reduced from 10.2 (3.1) to 7.6 (5.0), respectively (p < 0.001). New post-discharge opioid prescriptions did not differ between groups at 7 days, 5.1% (n=3) and 5.2% (n=3), respectively (p=0.983).


Conclusions: Implementing an oxycodone OPA at the time of discharge prescribing is feasible and associated with a decrease in total MME prescribed without an increase in new post-discharge opioid prescriptions.