Improving Intranasal Naloxone Prescribing Through EMR Modification and Automation

In 2017, approximately 11.4 million Americans used opioids inappropriately. Nearly 47,600 deaths in 2017 were attributable to overdose on opioids. Intranasal naloxone was approved by the Food and Drug Administration in 2015 as a rescue medication for opioid overdose. New York State launched a prescription drug monitoring program in 2012, the Internet System for Tracking Over-Prescribing (I-STOP), that required completion before dispensing any controlled substance. Currently, prescribing naloxone at our institution requires 10 clicks and 2 free text boxes. The goal of this project was to increase the prescribing of intranasal naloxone by utilizing EMR automation and visualization tools.

Our intervention embedded a section within the required I-STOP note, displaying the last date naloxone was prescribed and an option to "prescribe intranasal naloxone." If checked, a prepopulated order dialog box was generated.

Intranasal naloxone orders for the institution totaled 65 for 2 months before the intervention and 203 for 2 months after the intervention, with 112 (55%) coming directly from the I-STOP note modification. Ease of prescribing improved as total clicks were reduced from 10 to 2, and free text boxes from 2 to 0.

Our findings suggest that a clinical decision support system can be an effective way to increase hospital-wide naloxone prescribing rates. We were able to increase prescribing rates by more than three-fold, significantly increasing the availability of a rescue medication to individuals at high-risk for overdose. Intranasal naloxone prescribing increased with the implementation of a visual reminder and a more intuitive ordering experience while preserving provider autonomy.