Naloxone Coprescribing Across a Pediatric Health System: A Quality Improvement Initiative

Area of Science:

• Public Health
• Health Informatics
• Pharmacology

Background:

• Opioid overdose deaths remain a critical public health concern.
• Naloxone co-prescribing is a key strategy to reduce opioid-related morbidity and mortality.
• Ensuring equitable access to naloxone across diverse patient populations is essential.

Purpose of the Study:

• To improve naloxone co-prescribing rates to at least 80% for outpatients receiving opioid prescriptions.
• To implement and evaluate an electronic health record (EHR)-based intervention.
• To assess the impact of the intervention across diverse patient demographics.

Main Methods:

• A quality improvement initiative was conducted at a children's hospital from October 2023 to June 2025.
• An EHR-based automated alert system was implemented to prompt naloxone co-prescribing.
• Provider, nurse, patient/family, and pharmacist education was integrated into the initiative.

Main Results:

• Average monthly naloxone co-prescribing coverage increased from 3.0% to 84.1% enterprise-wide.
• Despite barriers like cost and stigma, 59.1% of naloxone orders were dispensed internally.
• Most providers found prescribing naloxone easy (81.8%) and were comfortable offering it (86.4%).

Conclusions:

• EHR-based prompts combined with comprehensive education effectively increased naloxone co-prescribing.
• The intervention demonstrated success in a large pediatric health system with a diverse patient population.
• This approach can serve as a model for improving naloxone access in similar healthcare settings.