EHR Could Help Prevent Overprescribing
One underutilized tool in the ASC setting in the battle against opioid addiction is the electronic health record (EHR). According to a July 2018 study in JAMA Surgery, decreasing the number of pills prescribed through an EHR is an economical and convenient way to prevent overprescribing and track the use of pain medications.
Using an EHR, ASCs can standardize order sets. Setting standard order sets for the treatment of pain by the anesthesia team would assist in the implementation of an effective multimodal analgesia protocol. Low-dose pain management requires multidisciplinary communication and coordination. An EHR allows multiple users to concurrently chart the same patient, which allows all providers to be aware of pain assessment, vital signs and medication administration for their patients throughout the continuum of care.
Addressing pain early requires lower doses of medication and will respond to non-medication pain control options (e.g., ice, positioning and relaxation techniques). The EHR also provides a medication summary for the current visit and shows providers the total amount of medications administered during the visit in real time. This prevents overmedication due to lack of information on how much has been given so far. The EHR’s medication reconciliation section also provides a convenient way to evaluate the patient’s home medications and any interaction they have with the planned discharge medications.
The plan for the treatment of postoperative pain starts before surgery and ends well after the patient has gone home. An EHR allows the surgery center and the care providers to design questionnaires specific to their surgeries and the known patient population. Gathering the appropriate information prior to surgery ensures that the best possible plan for the appropriate combination of pain therapies is ascertained and made available for the patient. The EHR also allows the center to design discharge instructions by procedure that include an educational document for patients being discharged on opioids, thereby substantiating the review of this document with the patient and/or family to stress adherence to the prescriptions and provide alternative interventions to opioids for pain management.
Last, an EHR can provide data for accountability and analysis. Reports that allow the center to track the usage of opioids by procedure, ordering provider and administering personnel also allow careful monitoring of opioid administration and trending of usage. The ability to report opioids given at an ASC helps reduce and track any potential overuse.
All health care providers must play a role in decreasing the use of opioids. One way to do that is to use the tools available in more inventive ways to care for, monitor and educate patients and our colleagues. The EHR is a new tool for ASCs that can play an effective role in this crisis.
The advice and opinions expressed in this column are those of the authors and do not represent official Ambulatory Surgery Center Association policy or opinion.