LAUSR

Health care systems have increasingly adopted a culture of opioid stewardship to promote the safer useofopioidsforpainmanagementinawaythatseekstooptimizepatientoutcomeswhilereducing the risks associated with opioids. Progress in opioid stewardship for acute pain has been advanced by 2 parallel lines of work. The first has been the development of procedure-specific guidelines that tailor the recommended number of opioid pills to amounts required to cover most patients’ analgesia needsbasedonpatientdataonopioidconsumptionafteragivenprocedure. 1 Thesecondlineofwork has demonstrated that lowering default opioid prescription order quantities in the electronic health record (EHR) can significantly reduce the number of pills prescribed, as clinicians tend to stay with default choices. 2,3 The study by Chua and colleagues 4 advances the field of opioid stewardship by combining both lines of work, demonstrating the effects of lowering EHR default opioid dosages to a lower amount chosen to be in line with the needs of most patients based on patient-reported data. The study by Chua et al 4 compared postoperative opioid prescribing patterns and patient-reported outcomes among individuals aged 12 to 25 years who underwent tonsillectomy before and afterthedefaultnumberofopioiddosageswasdecreasedfrom30to12intheproceduredischarge order set. Changes in outcomes after implementation of the order set with the lower default number were compared with a control practice of patients undergoing tonsillectomy in which there was no change to EHR order design. Overall, the study found a 45.5–percentage point increase in prescriptions for the new default dosage, which translated into a 29.2% relative reduction in the mean number of opioid dosages prescribed. This study makes several contributions to the existing literature. First, it contributes to the growing evidence base on the profound influence of EHR choice architecture and default orders on opioid prescribing for acute pain and clinician ordering behavior in general. Like prior studies