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. 2022 Jul 1;135(1):26-34.
doi: 10.1213/ANE.0000000000005976. Epub 2022 Jun 16.

Assessment of a Naloxone Coprescribing Alert for Patients at Risk of Opioid Overdose: A Quality Improvement Project

Scott D Nelson  1 , Allison B McCoy  1 , Hayley Rector  2 , Andrew J Teare  3 , Tyler W Barrett  4 , Elizabeth A Sigworth  5 , Qingxia Chen  5 , David A Edwards  6 , David E Marcovitz  7 , Adam Wright  1
Affiliations

Assessment of a Naloxone Coprescribing Alert for Patients at Risk of Opioid Overdose: A Quality Improvement Project

Scott D Nelson et al. Anesth Analg. .

Abstract

Background: Patients taking high doses of opioids, or taking opioids in combination with other central nervous system depressants, are at increased risk of opioid overdose. Coprescribing the opioid-reversal agent naloxone is an essential safety measure, recommended by the surgeon general, but the rate of naloxone coprescribing is low. Therefore, we set out to determine whether a targeted clinical decision support alert could increase the rate of naloxone coprescribing.

Methods: We conducted a before-after study from January 2019 to April 2021 at a large academic health system in the Southeast. We developed a targeted point of care decision support notification in the electronic health record to suggest ordering naloxone for patients who have a high risk of opioid overdose based on a high morphine equivalent daily dose (MEDD) ≥90 mg, concomitant benzodiazepine prescription, or a history of opioid use disorder or opioid overdose. We measured the rate of outpatient naloxone prescribing as our primary measure. A multivariable logistic regression model with robust variance to adjust for prescriptions within the same prescriber was implemented to estimate the association between alerts and naloxone coprescribing.

Results: The baseline naloxone coprescribing rate in 2019 was 0.28 (95% confidence interval [CI], 0.24-0.31) naloxone prescriptions per 100 opioid prescriptions. After alert implementation, the naloxone coprescribing rate increased to 4.51 (95% CI, 4.33-4.68) naloxone prescriptions per 100 opioid prescriptions (P < .001). The adjusted odds of naloxone coprescribing after alert implementation were approximately 28 times those during the baseline period (95% CI, 15-52).

Conclusions: A targeted decision support alert for patients at risk for opioid overdose significantly increased the rate of naloxone coprescribing and was relatively easy to build.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Naloxone coprescribing alert. MEDD indicates morphine equivalent daily dose.
Figure 2.
Figure 2.
Naloxone prescribing rates across the study period. COVID-19 indicates coronavirus disease 2019.
Figure 3.
Figure 3.
Patients at risk for overdose with and without naloxone.
See this image and copyright information in PMC

Comment in

References

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MeSH terms