Incidence of Naloxone-Use Before and After Implementing Opioid Safety Measures for Patients Hospitalised on General...

Opioids are high-risk medications that in overdose can lead to severe life-threatening or fatal adverse drug events. Inadvertent overdose is often the cause of opioid intoxication in hospitals. We introduced digital weight-based as-needed morphine and hydromorphone order sets at our hospital in November 2020 to prevent such adverse events. Naloxone given to reverse life-threatening opioid intoxication (LTOI) is a marker for these events in patient records.

The main aim was to ascertain the incidence of opioid-treated patients requiring naloxone for the management of LTOI on general wards before and after implementation of the order sets.

This investigator-driven, retrospective, observational, single-centre cohort study investigated naloxone administrations for LTOIs per 1000 opioid-treated patients, and per 1000 inpatients on general wards between 2019 and 2024 at the University Hospital Basel (USB). Prescription data and electronic hospital records were reviewed.

During the study period, a total of 78,438 patient cases received prescription opioids, of which 149 required naloxone for LTOIs. The incidence of naloxone-treated LTOIs per 1000 opioid treated patients was 3.21 prior to the introduction of the order sets and declined to 1.46 four years later (55% reduction, p = 0.002). There were 181,314 inpatients during the study period. The incidence of naloxone per 1000 inpatients was 1.14 before and 0.64 four years after the introduction of the order sets (44% reduction, p = 0.023).

We observed a significant reduction in the incidence of naloxone use for LTOI following the introduction of digital order sets for as-required morphine and hydromorphone indicating their effect to help promote safe opioid use and to improve patient safety in our hospital.