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Improving Intranasal Naloxone Prescribing Through EMR Modification and Automation.

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Electronic health record automation significantly increased intranasal naloxone prescribing by over three-fold. This improvement enhances access to opioid overdose rescue medication for at-risk individuals.

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Area of Science:

  • Clinical Informatics
  • Public Health
  • Pharmacology

Background:

  • Opioid overdose is a major public health crisis, with millions misusing opioids and tens of thousands of deaths annually.
  • Intranasal naloxone is a critical rescue medication for opioid overdose, approved by the FDA in 2015.
  • Existing prescribing workflows for intranasal naloxone were cumbersome, requiring multiple clicks and free-text entries.

Purpose of the Study:

  • To enhance the prescribing rate of intranasal naloxone within an institutional setting.
  • To leverage Electronic Medical Record (EMR) automation and visualization tools to streamline the naloxone prescription process.

Main Methods:

  • Implemented an intervention by embedding a naloxone prescribing option within the mandatory Internet System for Tracking Over-Prescribing (I-STOP) note.
  • The automated system displayed the last naloxone prescription date and offered a one-click option to prescribe, generating a prepopulated order.

Main Results:

  • Intranasal naloxone orders increased from 65 to 203 over two-month periods before and after the intervention, a more than three-fold increase.
  • 55% of the post-intervention orders originated directly from the modified I-STOP note.
  • Prescribing efficiency improved dramatically, reducing clicks from 10 to 2 and eliminating the need for free-text entries.

Conclusions:

  • Clinical decision support systems integrated into EMRs can effectively increase naloxone prescribing rates.
  • The intervention successfully boosted the availability of this life-saving medication for high-risk populations.
  • The automated system improved the ordering experience and increased prescribing without compromising provider autonomy.