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Clinical Decision Support to Increase Naloxone Co-prescribing from the Inpatient Setting
Jacob A Lebin1, Kaitlin Mitchell2, Katy E Trinkley3,4
1Department of Emergency Medicine, University of Colorado, Aurora, CO, USA. jacob.lebin@cuanschutz.edu.
Background:
Co-prescribing naloxone alongside opioid prescriptions reduces fatal opioid overdose risk in patients discharged from inpatient care, yet its adoption remains limited. Clinical decision support (CDS) tools are effective in increasing naloxone co-prescribing in emergency and primary care settings, but data from the inpatient setting is sparse.
Objective:
To evaluate the effectiveness of an electronic health record (EHR)-integrated CDS tool on rates of naloxone co-prescribing for patients discharged from inpatient care with high-risk opioid prescriptions.
Design:
This observational, pre-post study evaluated an EHR-embedded CDS tool implemented within an integrated health system between July 10, 2011, and July 15, 2023.
Study Sample:
Adult patients discharged from inpatient care with opioid prescriptions that met the Centers for Disease Control and Prevention high-risk criteria for opioid prescribing.
Interventions:
A multidisciplinary team designed an interruptive CDS best practice alert to identify high-risk opioid prescriptions. The CDS offered prescribers a one-click option to add a naloxone co-prescription.
Main Measures:
Outcomes are organized under the RE-AIM implementation science framework, with the primary outcome, Effectiveness, measured by the proportion of patients receiving a naloxone prescription. Secondary outcomes include patient Reach, clinician Adoption, and fidelity to Implementation. Bayesian structural time-series models were used to evaluate differences in outcomes.
Key Results:
During the study period, there were 355,465 inpatient discharges. In the post-intervention period, the CDS was triggered in 2.2% (7799/355,465) of all discharges and 6.36% (7799/122,643) of all discharge opioid prescriptions. Compared to the pre-implementation period, CDS was associated with a weekly increase in inpatient naloxone co-prescribing by 4.7 prescriptions per 100 opioid prescriptions (95% CI 4.3-5, p = 0.001).
Conclusions:
Implementation of an EHR-embedded CDS was associated with increased naloxone co-prescribing for high-risk opioid prescriptions in the inpatient setting. This finding demonstrates the potential of targeted, interruptive CDS tools to enhance opioid safety efforts in the inpatient setting.
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