Improving Naloxone Co-prescribing Through Clinical Decision Support.

Area of Science:

• Clinical Informatics
• Public Health
• Pharmacology

Background:

• National guidelines recommend naloxone co-prescription with high-risk medications, but rates are low.
• Low naloxone prescribing rates were observed at the institution.
• The study aimed to assess the impact of a clinical decision support (CDS) tool on naloxone co-prescribing.

Purpose of the Study:

• To determine if a CDS tool could increase naloxone co-prescribing rates with high-risk prescriptions.
• To evaluate the effectiveness of an electronic health record alert system in promoting naloxone prescriptions.

Main Methods:

• An electronic health record alert was implemented for high-risk opioid prescriptions lacking naloxone.
• The study analyzed opioid prescriptions from family and internal medicine at a university hospital (Nov 2020 - Feb 2022).
• The CDS tool offered an order set with automatic naloxone co-prescription and patient instructions.

Main Results:

• Concurrent naloxone prescriptions increased from 1.1% to 9.4% post-implementation (p<0.001).
• The intervention was applied across eight family medicine and internal medicine clinics.
• The increase was observed in patients receiving Schedule II opioid prescriptions ≥90 MME/day.

Conclusions:

• A single CDS tool demonstrated efficacy in increasing naloxone prescription rates.
• The CDS tool was easily implemented and improved appropriate naloxone co-prescribing.
• Further research is needed to determine the impact on overall mortality.