90 Increasing naloxone prescriptions through electronic medical record best practice advisory alerts

Document Type

Conference Proceeding

Publication Date

5-13-2024

Publication Title

Acad Emerg Med

Abstract

Background and Objectives: Deaths from opiate overdose remain a persistent public health crisis. Naloxone can rapidly reverse a fatal overdose and evidence shows reduced mortality when naloxone is available in the community. Though clinicians are generally willing to prescribe naloxone or order naloxone take home kits for high-risk patients, prescriptions and kit distribution remain inconsistent. We hypothesize that the implementation of a Best Practice Advisory (BPA) alert within the electronic medical record (EMR) can increase the number of naloxone take home kits and prescriptions given to high-risk patients in the ED. Methods: In this retrospective chart review, we identified cases using opioid use disorder (OUD) or opioid overdose ICD-10 codes over an 11-month period from November 2022 through September 2023. The chart review was inclusive of 10 EDs across a regional health system. After identification of cases with appropriate ICD-10 codes, charts were abstracted to determine whether naloxone was ordered as a take home kit or prescribed. In October 2023 an EMR BPA was implemented triggered by OUD and opioid overdose diagnosis ICD-10 codes with a disposition of discharge home. We reviewed cases from November 2023 to determine the number of BPA fires that prompted a clinician to order a naloxone take home kit or prescribe naloxone. Analysis included Fisher exact testing. Results: From November 2022 through September 2023 there were 869 cases identified meeting ICD-10 code criteria, in which 362 patients received either a naloxone take home kit or a prescription for naloxone at a rate of 41.7%. Chart review from November 2023 yielded 23 cases meeting ICD-10 codes and a discharge home disposition triggering the BPA to fire with 22 of those patients receiving a naloxone take home kit or a naloxone prescription at a rate of 95.7%. Of those that received naloxone, 19/22 (86.4%) received naloxone take home kit. The BPA was associated with a 6.6 times higher odds of receiving a naloxone kit or prescription (95% confidence interval: 2.2–19.7). Conclusion: Increasing naloxone availability should be considered an important part of a multi-pronged approach to combating the opioid epidemic. BPAs within the EMR could be a low-cost, effective intervention to increase naloxone availability for patients at-risk of opioid overdose in the ED. Further investigation is needed to explore patient centered outcomes related to ED naloxone and OUD.

Volume

31

Issue

S1

First Page

49

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