Hospital intervention significantly increases naloxone prescriptions

A hospital intervention designed to raise awareness of naloxone and remove prescribing barriers was associated with a 584% increase in prescriptions among patients at high risk for an opioid overdose, according to recent research.

The findings were presented during the virtual meeting of the Society of Hospital Medicine.

“The CDC recommends that patients at high risk for opioid overdose be prescribed naloxone,” Katherine Welter, MD, a hospitalist and clinical instructor at Northwestern Memorial Hospital, said during a presentation. “Those include patients who have a history of overdose or substance use disorder, those on high opioid doses — which means more than 50 morphine milligram equivalents [(MMEs)] a day — or if they have opioids with concurrent benzodiazepine use.”

At their own institution, Welter and colleagues found that only 1.1% of patients at high risk for an opioid overdose received naloxone in 2019. There were multiple barriers to prescriptions, Welter said, including a lack of knowledge on who should receive naloxone and when, and difficulty in prescribing it through the electronic health record.

To address these barriers, the researchers developed a pilot process to increase education, as well as a decision-support best practice advisory (BPA) that flags patients at high risk for opioid overdose.

“Our goal for this project was to both improve identifying these patients at high risk of opioid overdose and improve our rates of prescribing and providing education to these patients,” Welter said.

During the intervention, pharmacists identified high-risk patients during interdisciplinary rounds and, along with the hospitalists, helped educate the patients about their risks. In addition, attending nurses provided information about naloxone costs and highlighted information about naloxone on the after-visit summary.

The decision-support BPA alerted physicians of high-risk patients during discharge medicine reconciliation. It included an order for the naloxone nasal spray and the instruction to talk to the pharmacist about providing education.

After implementation, the researchers observed a “major increase” in naloxone prescriptions, Welter said. The prescribing rate increased from 3.7 prescriptions per month during a pre-intervention period (September 2019 to July 2020) to 25.3 prescriptions per month during the post-intervention period (August 2020 to March 2021; P = .001).

The BPA was linked to 79% of these prescriptions, according to Welter. The overall growth rate was 584%, she said.

“In conclusion, we were able to successfully increase our naloxone prescription and education through a multidisciplinary approach, supplementing both education and EHR support,” Welter said. “We hope that this can help you in your own hospital to provide this prescription to ... patients who need it most.”