35 Increasing Naloxone Prescriptions Through Electronic Medical Record Best Practice Advisory Alerts

Document Type

Conference Proceeding

Publication Date

10-1-2022

Publication Title

Ann Emerg Med

Abstract

Study Objectives: Overdoses are now the leading cause of injury-related death in the United States with recent increases influenced by multiple factors including the COVID-19 pandemic. Among the most recent overdose deaths, about 75% involved a prescription or illicit opioid. Naloxone can rapidly reverse fatal overdose and evidence shows reduced mortality when naloxone is available in the community. Although emergency physicians are generally willing to prescribe naloxone to patients at risk of opioid overdoses, prescriptions remain uncommon. We hypothesize that the implementation of a Best Practice Advisory (BPA) alert within the electronic medical record (EMR) can increase the number of naloxone prescriptions given to high risk patients within the emergency department (ED). Study Design/Methods: In this retrospective chart review, we measured the number of naloxone prescriptions in a 5-month period prior to the initiation of the BPA and compared that to the number of naloxone prescriptions in the 5-month period after the initiation of the BPA. The chart review was inclusive of 9 EDs across a health system with a total annual volume of 450,000 visits per year. We also quantified the total number of BPA triggers and the action taken by the type of ED clinician including physician, resident, physician assistant and nurse practitioner. The BPA was designed to prompt a prescription for naloxone for patients at-risk for opioid overdose that meet criteria including: patients prescribed opioids with comorbidities including chronic lung or heart disease, opioid use disorder, history of opioid overdose, and those with an opioid prescription greater than 50 morphine milligram equivalents per day. Results/Findings: In the 5-month period after naloxone BPA initiation, there were 740 naloxone prescriptions. This compares to 180 naloxone prescriptions in the 5-month period prior to initiation of the BPA, a 311% increase in naloxone prescriptions after BPA initiation. The BPA fired 2,450 times after initiation and the clinician clicked to “accept” the BPA 1,428, a 58.3% acceptance rate. The rates of ED clinicians clicking “accept” who encountered the naloxone BPA by the type of ED clinician were as follows: physicians (56.5%), residents (67.2%), physician assistants (54.8%), nurse practitioners (42.5%). Conclusion: Increasing naloxone availability should be considered an important part of a multi-pronged approach to combatting our current opioid epidemic. BPAs within the EMR could be a low-cost, effective intervention to increase naloxone prescription rates for patients at-risk of opioid overdose in the ED. Further investigation is needed to determine pharmacy fill rates of naloxone prescriptions and understand clinician perspectives toward naloxone prescription in order to characterize the most effective model for naloxone distribution. No, authors do not have interests to disclose

Volume

80

Issue

4

First Page

S16

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