A Performance Improvement Prescribing Guideline Reduces Opioid Prescriptions for Emergency Department Dental Pain Patients

Document Type


Publication Date



Emergency Medicine

Journal Title

Annals of Emergency Medicine

MeSH Headings

Adolescent, Adult, Aged, Aged, 80 and over, Analgesics, Opioid, Emergency Service, Hospital, Female, Health Services Misuse, Humans, Male, Middle Aged, Opioid-Related Disorders, Practice Guidelines as Topic, Practice Patterns, Physicians', Prescriptions, Toothache, Young Adult


STUDY OBJECTIVE: In an effort to reduce prescription opioid abuse originating from our institution, we implement and measure the effect of a prescribing guideline on the rate of emergency department (ED) opioid prescriptions written for patients presenting with dental pain, a complaint previously associated with drug-seeking behavior.

METHODS: After implementing a departmental guideline on controlled substance prescriptions, we performed a structured before-and-after chart review of dental pain patients aged 16 and older.

RESULTS: Before the guideline, the rate of opioid prescription was 59% (302/515). After implementation, the rate was 42% (65/153). The absolute decrease in rates was 17% (95% confidence interval 7% to 25%). Additionally, in comparing the 12-month period before and after implementation, the dental pain visit rate decreased from 26 to 21 per 1,000 ED visits (95% confidence interval of decrease 2 to 9 visits/1,000).

CONCLUSION: A performance improvement program involving a departmental prescribing guideline was associated with a reduction in the rate of opioid prescriptions and visits for ED patients presenting with dental pain.



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