Dot Phrase Utilization and Opioid Prescription at Discharge for Subarachnoid Hemorrhage Patients

Background and Purpose Subarachnoid hemorrhage (SAH) frequently causes headaches that debilitate patients in the intensive care unit and persist for many patients in follow-up. Current literature suggests that opioids are ineffective for treating SAH pain despite their widespread use and perceived efficacy. There is evidence that implementation of dot phrases in note templates and electronic medical record alerts can positively influence prescriber behavior, including with reducing opioid prescriptions in the primary care setting. Methods We assessed rates of opioid prescription in our SAH population and added a standardized dot phrase to admission and discharge summaries. This dot phrase prompted providers to answer whether the patient was being prescribed opioids, the rationale for this, and the plan for weaning. Results There was a trend towards overall reduced opioid prescription at discharge after dot phrase implementation. On analysis of the whole cohort, in cases where the dot phrase was used, the rate of opioid prescription at discharge was 14% versus 42% without (chi-square P = 0.024). However, dot phrase usage was higher on the neurovascular service compared to neurosurgery (77% vs 39%, Fisher’s exact P = 0.043), and the neurovascular service had lower opioid prescription at discharge overall compared to neurosurgery (6% vs 43%, Fisher’s exact P = 0.007). Conclusions Our results highlight differences in prescription patterns among admitting services for patients with SAH. The results suggest that dot phrase implementation could help reduce opioid prescription at discharge for this patient population, but this may be confounded by higher rates of dot phrase usage on the neurovascular service.