title: A performance improvement prescribing guideline reduces opioid prescriptions for emergency department dental pain patients.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors: Department of Emergency Medicine, Miles Memorial Hospital, Damariscotta, ME, USA.
authors: Timothy R
authors: TR
authors: Fox
authors: James
authors: J
authors: Li
authors: Sandra
authors: S
authors: Stevens
authors: Tracy
authors: T
authors: Tippie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006300:Health Services Misuse / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055656:Prescriptions; D014098:Toothache / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid