{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:50:49Z","timestamp":1760143849748,"version":"build-2065373602"},"reference-count":42,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012503","name":"Royal Hobart Hospital Research Foundation Incorporated","doi-asserted-by":"publisher","award":["22-104"],"award-info":[{"award-number":["22-104"]}],"id":[{"id":"10.13039\/100012503","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>Opioid prescribing and dispensing from emergency departments is a noteworthy issue given widespread opioid misuse and diversion in many countries, contributing both physical and economic harm to the population. High patient numbers and the stochastic nature of acute emergency presentations to emergency departments (EDs) introduce challenges for prescribers who are considering opioid stewardship principles. This study investigated the effect of changes to electronic prescribing software on prescriptions with an auto-populated quantity of oxycodone immediate release (IR) from an Australian tertiary emergency department following the implementation of national recommendations for reduced pack sizes. A retrospective review of oxycodone IR prescriptions over two six-month periods between 2019 and 2021 was undertaken, either side of a software adjustment to reduce the default quantities of tablets prescribed from 20 to 10. Patient demographic details were collected, and prescriber years of practice calculated for inclusion in linear mixed effects regression modelling. A reduction in the median number of tablets prescribed per prescription following the software changes (13.5 to 10.0, p &lt; 0.001) with little change in the underlying characteristics of the patient or prescriber populations was observed, as well as an 11.65% reduction in the total number of tablets prescribed. The prescriber\u2019s years of practice, patient age and patient sex were found to influence increased prescription sizes. Reduced quantity of oxycodone tablets prescribed was achieved by alteration of prescribing software prefill parameters, providing further evidence to support systems-based policy interventions to influence health care providers behaviour and to act as a forcing function for prescribers to consider opioid stewardship principles.<\/jats:p>","DOI":"10.3390\/pharmacy12020044","type":"journal-article","created":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T06:07:53Z","timestamp":1709273273000},"page":"44","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Influences of Software Changes on Oxycodone Prescribing at an Australian Tertiary Emergency Department: A Retrospective Review"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5130-7457","authenticated-orcid":false,"given":"Giles","family":"Barrington","sequence":"first","affiliation":[{"name":"Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Davis","sequence":"additional","affiliation":[{"name":"Austin Health, Heidelberg 3084, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9412-8288","authenticated-orcid":false,"given":"Zach","family":"Aandahl","sequence":"additional","affiliation":[{"name":"School of Natural Sciences, University of Tasmania, Hobart 7000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7954-9455","authenticated-orcid":false,"given":"Brodie-Anne","family":"Hose","sequence":"additional","affiliation":[{"name":"Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitchell","family":"Arthur","sequence":"additional","affiliation":[{"name":"Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8890-1457","authenticated-orcid":false,"given":"Viet","family":"Tran","sequence":"additional","affiliation":[{"name":"Royal Hobart Hospital, Tasmanian Health Service, Hobart 7000, Australia"},{"name":"School of Medicine, University of Tasmania, Hobart 7000, Australia"},{"name":"Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,1]]},"reference":[{"key":"ref_1","unstructured":"Therapeutic Goods Administration (2023, December 18). Prescription Opioids: Information for Health Professionals, Available online: https:\/\/www.tga.gov.au\/resources\/resource\/guidance\/prescription-opioids-information-health-professionals."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"268","DOI":"10.15441\/ceem.21.161","article-title":"Pain management in the emergency department: A clinical review","volume":"8","author":"Motov","year":"2021","journal-title":"Clin. Exp. Emerg. Med."},{"key":"ref_3","unstructured":"Australian Institute of Health and Welfare (2018). Opioid Harm in Australia and Comparisons between Australia and Canada, AIHW."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.ajem.2019.06.011","article-title":"Trends in emergency physician opioid prescribing practices during the United States opioid crisis","volume":"38","author":"Gleber","year":"2020","journal-title":"Am. J. Emerg. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/j.amepre.2018.01.034","article-title":"Trends in medical use of opioids in the US, 2006\u20132016","volume":"54","author":"Piper","year":"2018","journal-title":"Am. J. Prev. Med."},{"key":"ref_6","first-page":"43","article-title":"The opioid crisis: Prevalence and markets of opioids","volume":"34","author":"Gardner","year":"2022","journal-title":"Forensic Sci. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e297","DOI":"10.1016\/j.amepre.2021.10.022","article-title":"Opioids Dispensed in the US by Prescribing Specialty, 2012\u20132017","volume":"62","author":"Gurka","year":"2022","journal-title":"Am. J. Prev. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1007\/s40429-018-0231-x","article-title":"The threat of an international opioid crisis","volume":"5","author":"Nolan","year":"2018","journal-title":"Curr. Addict. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s40122-018-0096-7","article-title":"A review of the opioid epidemic: What do we do about it?","volume":"7","author":"Shipton","year":"2018","journal-title":"Pain. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"101198","DOI":"10.1016\/j.eclinm.2021.101198","article-title":"Global consumption of prescription opioid analgesics between 2009\u20132019: A country-level observational study","volume":"42","author":"Jayawardana","year":"2021","journal-title":"EClinicalMedicine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1080\/10826084.2017.1305415","article-title":"Prescription Opioid Misuse and Public Health Approach in Australia","volume":"53","author":"Kovitwanichkanont","year":"2018","journal-title":"Subst. Use Misuse"},{"key":"ref_12","unstructured":"Chrzanowska, A., Man, N., Sutherland, R., Degenhardt, L., and Peacock, A. (2021). Trends in Drug-Induced Deaths in Australia, 1997\u20132019, National Drug and Alcohol Research Centre, UNSW Sydney."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1071\/AH18245","article-title":"Trends in opioid prescribing in Australia: A systematic review","volume":"44","author":"Donovan","year":"2020","journal-title":"Aust. Health Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1111\/1742-6723.13545","article-title":"Oxycodone prescribing in the emergency department during the opioid crisis","volume":"32","author":"Pouryahya","year":"2020","journal-title":"Emerg. Med. Australas."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1111\/1742-6723.13192","article-title":"Modifying emergency department electronic prescribing for outpatient opioid analgesia","volume":"31","author":"Schwartz","year":"2019","journal-title":"Emerg. Med. Australas."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e12476","DOI":"10.1002\/emp2.12476","article-title":"Incidence of opioid use disorder in the year after discharge from an emergency department encounter","volume":"2","author":"Punches","year":"2021","journal-title":"J. Am. Coll. Emerg. Physicians Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1111\/papr.12568","article-title":"The contribution of the emergency department to opioid pain reliever misuse and diversion: A critical review","volume":"17","author":"Lyapustina","year":"2017","journal-title":"Pain Pract."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e022649","DOI":"10.1136\/bmjopen-2018-022649","article-title":"Quantity of opioids consumed following an emergency department visit for acute pain: A Canadian prospective cohort study","volume":"8","author":"Daoust","year":"2018","journal-title":"BMJ Open"},{"key":"ref_19","first-page":"CD000259","article-title":"Audit and feedback: Effects on professional practice and healthcare outcomes","volume":"6","author":"Ivers","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1111\/acem.13400","article-title":"Effect of a Data-driven Intervention on Opioid Prescribing Intensity Among Emergency Department Providers: A Randomized Controlled Trial","volume":"25","author":"Michael","year":"2018","journal-title":"Acad. Emerg. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1097\/CXA.0000000000000019","article-title":"Does physician education and factsheet impact on safe opioid use in emergency patients?","volume":"9","author":"Chan","year":"2018","journal-title":"Can. J. Addict."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1016\/j.ajem.2017.06.024","article-title":"Effect of an emergency department opioid prescription policy on prescribing patterns","volume":"35","author":"Chacko","year":"2017","journal-title":"Am. J. Emerg. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"E79","DOI":"10.9778\/cmajo.20200071","article-title":"Impact of an emergency department opioid prescribing guideline on emergency physician behaviour and incidence of overdose in the Saskatoon Health Region: A retrospective pre-post implementation analysis","volume":"9","author":"Hartmann","year":"2021","journal-title":"CMAJ Open"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"23259671211027546","DOI":"10.1177\/23259671211027546","article-title":"Mandatory Prescription Limits and Opioid Use After Anterior Cruciate Ligament Reconstruction","volume":"9","author":"Kamaci","year":"2021","journal-title":"Orthop. J. Sports Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1694","DOI":"10.1148\/rg.2015150107","article-title":"Improving safety through human factors engineering","volume":"35","author":"Siewert","year":"2015","journal-title":"Radiographics"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"392","DOI":"10.5811\/westjem.2017.10.33798","article-title":"By Default: The Effect of Prepopulated Prescription Quantities on Opioid Prescribing in the Emergency Department","volume":"19","author":"Santistevan","year":"2018","journal-title":"West. J. Emerg. Med."},{"key":"ref_27","unstructured":"NPS Medicinewise (2023, January 01). Opioids: New and Amended PBS Listings. Available online: https:\/\/www.nps.org.au\/radar\/articles\/opioids-new-and-amended-pbs-listings."},{"key":"ref_28","unstructured":"R Core Team (2016). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"112376","DOI":"10.1016\/j.psychres.2019.04.025","article-title":"Implementation science: What is it and why should I care?","volume":"283","author":"Bauer","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/AIA.0000000000000336","article-title":"Nudge theory in anesthesiology clinical practice","volume":"59","author":"Kraus","year":"2021","journal-title":"Int. Anesthesiol. Clin."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1001\/jamainternmed.2019.6544","article-title":"Association of default electronic medical record settings with health care professional patterns of opioid prescribing in emergency departments: A randomized quality improvement study","volume":"180","author":"Montoy","year":"2020","journal-title":"JAMA Intern. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s11606-017-4286-5","article-title":"Association between electronic medical record implementation of default opioid prescription quantities and prescribing behavior in two emergency departments","volume":"33","author":"Delgado","year":"2018","journal-title":"J. Gen. Intern. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1111\/acem.14717","article-title":"Disparities in Emergency Department and Urgent Care Opioid Prescribing Before and After Randomized Clinician Feedback Interventions","volume":"30","author":"Crowley","year":"2023","journal-title":"Acad. Emerg. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1093\/pm\/pnaa048","article-title":"Patient-reported opioid pill consumption after an ED visit: How many pills are people using?","volume":"22","author":"McCarthy","year":"2021","journal-title":"Pain Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.jen.2006.01.010","article-title":"Disparities in analgesia and opioid prescribing practices for patients with musculoskeletal pain in the emergency department","volume":"32","author":"Heins","year":"2006","journal-title":"J. Emerg. Nurs."},{"key":"ref_36","first-page":"e5678","article-title":"The Association Between Patient Visit Demographics and Opioid Analgesic Received in the Emergency Department","volume":"11","author":"Richards","year":"2019","journal-title":"Cureus"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"678","DOI":"10.5811\/westjem.2018.5.37853","article-title":"Opioid Administration and Prescribing in Older Adults in U.S. Emergency Departments (2005\u20132015)","volume":"19","author":"Marra","year":"2018","journal-title":"West. J. Emerg. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.annemergmed.2016.01.026","article-title":"Opioids and the emergency physician: Ducking between pendulum swings","volume":"68","author":"Yealy","year":"2016","journal-title":"Ann. Emerg. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/S0196-0644(95)70107-9","article-title":"Gender-associated differences in emergency department pain management","volume":"26","author":"Raftery","year":"1995","journal-title":"Ann. Emerg. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.5811\/westjem.2017.7.33306","article-title":"Emergency department attending physician variation in opioid prescribing in low acuity back pain","volume":"18","author":"Hoppe","year":"2017","journal-title":"West. J. Emerg. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1111\/j.1526-4637.2008.00524.x","article-title":"Impact of physician and patient gender on pain management in the emergency department\u2014A multicenter study","volume":"10","author":"Safdar","year":"2009","journal-title":"Pain Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"428","DOI":"10.5811\/westjem.2019.3.39311","article-title":"Variations in Opioid Prescribing Behavior by Physician Training","volume":"20","author":"Leventhal","year":"2019","journal-title":"West. J. Emerg. Med."}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/12\/2\/44\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:07:37Z","timestamp":1760105257000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/12\/2\/44"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,1]]},"references-count":42,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["pharmacy12020044"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy12020044","relation":{},"ISSN":["2226-4787"],"issn-type":[{"type":"electronic","value":"2226-4787"}],"subject":[],"published":{"date-parts":[[2024,3,1]]}}}