Increasing Naloxone Prescribing in the Emergency Department Through Education and Electronic Medical Record Work-Aids

Funke, Mary; Kaplan, Marcus C; Glover, Holly; Schramm-Sapyta, Nicole L.; Muzyk, Andrew J.; Mando‐Vandrick, Jennifer; Gordee, Alexander; Kuchibhatla, Maragatha; Sterrett, Emily; Eucker, Stephanie A.

doi:10.1016/j.jcjq.2021.03.002

Cited by 16 publications

(13 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous work on naloxone prescribing to patients who presented to EDs with opioid overdoses or opioid use disorder showed similar, consistent increases. 22,43 Our results correlate well with these findings, also showing increases in naloxone prescribing that were sustained at the end of the study period. Naloxone prescribing rates in our study remained lower than in a recent, similar study evaluating an EHR prompt enacted withing the Kaiser Permanente Southern California health system.…”

Section: Discussionsupporting

confidence: 88%

“…THN programs have been shown to be effective in decreasing mortality among high-risk individuals, 18,19 and have been successfully implemented in emergency departments and hospital medicine wards. [20][21][22][23] Although THN programs often target patients with use of illicit opioids, programs that include co-prescriptions of naloxone for patients on prescribed opioids have also shown feasibility and effectiveness. 24,25 Naloxone dispensing rates remain low across all states.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Electronic Advisories Increase Naloxone Prescribing Across Health Care Settings

et al. 2022

View full text Add to dashboard Cite

BACKGROUND: Naloxone is a li fe-saving, yet underprescribed, medication that is recommended to be provided to patients at high risk of opioid overdose. OBJECTIVE: We set out to evaluate the changes in prescriber practices due to the use of an electronic health record (EHR) advisory that prompted opioid prescribers to co-prescribe naloxone when prescribing a high-dose opioid. It also provided prescribers with guidance on decreasing opioid doses for safety. DESIGN: This was a retrospective chart abstraction study looking at all opioid prescriptions and all naloxone prescriptions written as emergency department (ED) discharge, inpatient hospital discharge, or outpatient medi-

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Electronic Advisories Increase Naloxone Prescribing Across Health Care Settings

et al. 2022

View full text Add to dashboard Cite

show abstract

“…31 Historically, successful best practice alerts have integrated extensive education in tandem with an actionable alert feature. 32 Although our best practice alert was designed and executed with the best intention of adhering to the five "rights" of clinical decision support (right information, to the right person, in the right format, through the right channel, at the right time), insufficient clinician engagement may have contributed to a lack of comprehension or awareness. 33 Moreover, we cannot presuppose that all incorporated electronic alerts will be advantageous or lead to positive change.…”

Section: Discussionmentioning

confidence: 99%

Best Practice Alerts Informed by Inpatient Opioid Intake to Reduce Opioid Prescribing after Surgery (PRIOR): A Cluster Randomized Multiple Crossover Trial

Rolfzen

Mascha

et al. 2023

Anesthesiology

View full text Add to dashboard Cite

Background Over-prescription of opioids after surgery remains common. Residual and unnecessarily prescribed opioids can provide a reservoir for nonmedical use. We therefore tested the hypothesis that a decision-support tool embedded in electronic health records guides clinicians to prescribe fewer opioids at discharge after inpatient surgery. Methods We studied 21,689 surgical inpatient discharges in a cluster randomized multiple crossover trial from July 2020 to June 2021 in four Colorado hospitals. Hospital-level clusters were randomized to alternating eight-week periods during which an electronic decision-support tool recommended tailored discharge opioid prescriptions based on prior inpatient opioid intake. During active alert periods, the alert was displayed to clinicians when the proposed opioid prescription exceeded recommended amounts. No alerts were displayed during inactive periods. Carryover effects were mitigated by including 4-week washout periods. The primary outcome was oral morphine milligram equivalents prescribed at discharge. Secondary outcomes included combination opioid/non-opioid prescriptions and additional opioid prescriptions until day 28 after discharge. A vigorous state-wide opioid education and awareness campaign was in place during the trial. Results The total postdischarge opioid prescription was a median [quartiles] of 75 [0, 225] oral morphine milligram equivalents among 11,003 patients discharged when the alerts were active and 100 [0, 225] morphine milligram equivalents in 10,686 patients when the alerts were inactive, with an estimated ratio of geometric means of 0.95 (95% CI: 0.80, 1.13; P = 0.586). The alert was displayed in 28% (3,074/11,003) of the discharges during the active alert period. There was no relationship between the alert and prescribed opioid/non-opioid combination medications or additional opioid prescriptions written after discharge. Conclusions A decision-support tool incorporated into electronic medical records did not reduce discharge opioid prescribing for postoperative patients in the context of vigorous opioid education and awareness efforts. Opioid prescribing alerts might yet be valuable in other contexts. Registered at ClinicalTrials.gov (NCT04446975)

show abstract

“…34 A more recent study assessing methods of increasing THN prescribing in the ED found that although barriers remain, improved, targeted staff training, and the use of work aids such as best-practice advisory tools, can increase the prescription of THN kits in the ED. 35 It may also be possible to identify patients for administration of a THN kit at the time of follow-up, rather than during the emergency episode.…”

Section: Implications For Research Policy Practicementioning

confidence: 99%

Is a definitive trial of Take-Home Naloxone in emergency settings indicated? Results of a cluster randomised feasibility study

Snooks,

Jones,

Bell

et al. 2024

Preprint

View full text Add to dashboard Cite

Background Opioids kill more people than any other class of drug. Naloxone is an opioid antagonist which can be distributed in kits for peer administration. We aimed to determine feasibility of undertaking a definitive randomised controlled trial (RCT) of Take-home Naloxone (THN) in emergency settings. Methods Using individual-level-routine health records (2015-21) we tested feasibility of developing a discriminant function to identify people at high-risk of fatal opioid poisoning for outcome comparisons. We undertook a clustered RCT on paired UK Emergency Department (ED) and ambulance service sites. At intervention sites, we recruited practitioners to administer THN to patients presenting with opioid overdose or related condition during ta 1year recruitment period, 2019 – 21. We assessed feasibility of intervention and trial methods against predetermined progression criteria. Results Within routine health records on the population of Wales (~3,200,000), we identified 1,105 adult deaths from opioid poisoning, of whom 307 (27.8%) had no ED or drugs service contacts in the year before death. At a predicted probability threshold of 0.0003, a discriminant function based on demographics and recent healthcare contacts identified 809 opioid related deaths within 1 year (sensitivity 74.7%) in 989,151 people, missing 274 cases. Lowering the threshold to 0.0002 increased sensitivity to 86.1% but included a further 608,191 non-cases; raising it to 0.0004 reduced sensitivity to 65.4% and inclusion of non-cases to 646,750. At two intervention sites, randomly selected from 4: 299/687 (43.5%) clinical staff were trained; 60/277 eligible patients (21.7%) were supplied with a THN kit and no adverse events were reported. Conclusion With a low incidence of opioid-related death and significant proportion with no contact with ED or drug services in the year before death, the numbers needed to reach a reasonable sensitivity was very high. This study did not meet progression criteria, a fully powered trial is not planned. Trial Registration ISRCTN13232859 (Registered 16/02/2018)

show abstract

Increasing Naloxone Prescribing in the Emergency Department Through Education and Electronic Medical Record Work-Aids

Cited by 16 publications

References 28 publications

Electronic Advisories Increase Naloxone Prescribing Across Health Care Settings

Electronic Advisories Increase Naloxone Prescribing Across Health Care Settings

Best Practice Alerts Informed by Inpatient Opioid Intake to Reduce Opioid Prescribing after Surgery (PRIOR): A Cluster Randomized Multiple Crossover Trial

Is a definitive trial of Take-Home Naloxone in emergency settings indicated? Results of a cluster randomised feasibility study

Contact Info

Product

Resources

About