Naloxone coprescribing best practice advisory for patients at high risk for opioid-related adverse events

Abstract

Objective: To implement an electronic health record best practice advisory (BPA) to promote coprescribing of naloxone to patients at high risk of serious opioid-related adverse events (ORADEs).

Design: This pre-post quasi-experimental study evaluated 9 months of opioid and naloxone prescription data before and after BPA implementation.

Setting: The Froedtert & the Medical College of Wisconsin enterprise is comprised of 45 ambulatory clinics and 10 hospitals, including the only adult Level 1 trauma center in eastern Wisconsin.

Patients: Patients who received opioid prescriptions in the preimplementation time period (n = 106,615 prescriptions) and post-implementation time period (n = 107,352 prescriptions) were included.

Interventions: BPA activation criteria included entry of a prescription with a morphine equivalent daily dose of 50 or greater with at least a 5-day supply, concomitant opioid and benzodiazepine prescription, or opioid prescription entry for a patient with a documented history of opioid overdose. The BPA defaulted to coprescribe naloxone, while also providing suppression options.

Main outcome measure: The primary endpoint was the change in naloxone prescription rate for patients on chronic opioid therapy (COT) with a morphine milligram equivalent daily dose (MEDD) per day of 50 or greater.

Results: The naloxone coprescription rate for COT patients with a MEDD of 50 or greater increased from 12.2 percent (95 percent confidence interval [CI] 10.4-14.4) to 34.79 percent (95 percent CI 31.8-38.2) after the BPA was implemented (odds ratio 2.85, 95 percent CI 2.37-3.42, p-value < 0.001).

Conclusions: Use of BPA increased the rate of naloxone coprescribing for patients at risk of serious ORADE.