COMBATING THE OPIOID EPIDEMIC THROUGH A NALOXONE BEST PRACTICE ALERT AND OTHER QUALITY IMPROVEMENT INTERVENTIONS WITHIN AN ACADEMIC HOSPITAL

Background: Drug overdose deaths involving opioids are on the rise in the setting of the current opioid epidemic in the United States (US).1 In 2017 there were ~46.6 drug overdose deaths a day in the US involving prescription opioids.1 Naloxone is a proven and effective opioid antagonist that is FDA approved for use in the setting of CNS depression or respiratory depression from opioid overdose.3 Despite this known benefit, in the US in 2018 for every 69 high-dose opioid prescriptions written, only one concurrent naloxone prescription was written.2 Similarly, we found that between January 2018 to January 2019, only 2% of patients at high risk for an opioid overdose discharged from our academic institution were being prescribed naloxone. This project aimed to increase prescriptions for naloxone using quality improvement principles which included assessment of provider attitudes, provider education and an electronic health record (EHR) alert.

Methods: The population studied included any patient discharged from our academic institution who met criteria for naloxone. Criteria were defined as: opioid prescription without active naloxone prescription + MME>/=90 or history of an opioid overdose or history of an opioid use disorder. Interventions included provider education and institution of a best practice alert (BPA) within the EHR triggering providers to order naloxone when patients met criteria. A retrospective analysis was completed using data collected through the EHR system to analyze the effects of these interventions. Additional data regarding provider attitudes towards naloxone and the BPA was also obtained through surveys. This project is pending IRB approval.

Results: A survey of providers suggested that only 16.7% of those surveyed were aware that naloxone is indicated when prescribing opioids at a dose of > 50MME. Following implementation of the BPA, the rate of prescriptions for naloxone to those patients at high risk for overdose increased to 57.6% compared to 2% prior to the BPA (91 orders placed out of 158 BPA triggers). 76% of these prescriptions sent to the hospital pharmacy were filled by patients. Providers were surveyed after implementation of the BPA and 90% felt that they were prescribing more naloxone to high-risk patients since its release. Additionally, 80% of providers felt that the BPA was extremely helpful in improving their rate of naloxone prescriptions for high-risk patients.

Conclusions: Deaths related to opioid overdoses are prevalent throughout the United States despite attempts to combat the current opioid epidemic. Prescription medications play a role in these deaths. Healthcare systems can institute interventions to help reduce opioid overdose deaths through the prescription of naloxone. Implementation of an EHR-based BPA at an academic institution can increase the rate at which naloxone is being prescribed for those at risk for opioid overdoses.