Increasing Naloxone Coprescription for High-Risk Opioid Prescribing: A Hospitalist-Focused Quality Improvement...

High opioid doses markedly increase fatal overdose risk, for which the 2022 Centers for Disease Control and Prevention opioid guidelines reinforce naloxone coprescription among patients receiving them. Purpose: To reduce the percentage of patients discharged with a prescription of ≥90 morphine equivalents daily dose (MEDD) without naloxone in their medication list by 30%, from 54.20% to 37.94%, without negatively affecting provider satisfaction.

This project was conducted in the Hospital Internal Medicine inpatient group at our institution from August 20, 2024, to June 30, 2025. Baseline and improvement metrics were obtained from the Epic opioid stewardship dashboard. The improvement measure was the percentage of patients discharged with ≥90 MEDD without naloxone. Provider satisfaction with the naloxone coprescribing process served as the balancing measure, assessed through surveys at baseline and postinterventions. The first intervention (January 2025) included staff education on MEDD calculation, naloxone indications, and prescription, supported by pharmacist reminders to providers. The second (March 2025) introduced algorithms for providers and pharmacists to standardize decision making. Proportions were compared using one-sided and two-sided proportion z-tests.

The percentage of patients with ≥90 MEDD discharged without naloxone decreased from 54.2% at baseline (n = 352/651) to 39.4% after the first intervention and to an average of 25.0% (n = 26/104) across 3 months after the second intervention (z = 5.53, p < .0001). Provider satisfaction increased from 44% to 73% postinterventions (p = .016).

Targeted education, specialized algorithms, and reminders substantially improved naloxone coprescription rates among patients receiving ≥90 MEDD at discharge. Implications: Other institutions could reproduce this project in efforts to decrease fatal overdoses.