Implementing Clinical Decision Support Aimed at Reducing Co-Prescribing of Opioids and Benzodiazepines at Adventist HealthCare Maryland
Author: Monica Coley, MPH (2023)
Primary advisor: Debora Simmons, PhD
Committee members: Tiffany Champagne-Langabeer, PhD, John Glaser, PhD and Angela Ross, DNP
DHI Translational Project, The UTHealth Houston School of Biomedical Informatics
Clinical Decision Support (CDS) leverages computerized toolsets to provide condition specific guidance that aids providers in clinical decision making processes (AHRQ, 2019; AMIA, n.d.; ONC, 2018). Research has shown that applying CDS, interruptive within the electronic health record (EHR) prescribing workflow, can assist providers with avoiding unsafe medication prescribing, such as 1) multiple opioids and 2) opioid-benzodiazepine combinations (Malte et al., 2018; Smith et al., 2019, Price-Haywood et al., 2020; Nelson et al., 2022). In an effort to decrease the co-prescribing rate for 1) multiple opioids and 2) opioid-benzodiazepine combinations, Adventist HealthCare Maryland (AHC) launched a performance improvement project in 2022 that focused on decreasing the health system’s average co-prescribing rate to fall within the 2% to 5% range. To achieve this goal, AHC implemented two (2) EHR-based CDS alerts that were interruptive within the prescribing workflow. Project results showed that AHC was not able to reach the 2% to 5% range, yet the overall co-prescribing rate decreased by 1.56%. The limitations with EHR functionality, differences between the planned design versus actual implementation of the alerts, alerting gaps, and alerting noise were all areas that needed to be improved to determine if the performance target could have been met with the CDS. Some recommended paths forward were to 1) address the design and technical challenges with the alerts, 2) enhance provider-level reporting around opioid and benzodiazepine prescribing to hospital and departmental administration, 3) continue educational efforts around co-prescribing, particularly for the top co-prescribing roles, and 4) explore a consistent role of pharmacy in reviewing prescriptions during the discharge process.