Increasing Naloxone Prescribing in the Emergency Department through Education and Electronic Medical Record Work-Aids

Abstract Background Emergency Department (ED) visits for opioid overdose continue to rise. Evidence-based harm reduction strategies for opioid use disorder (OUD) such as providing home naloxone can save lives, but ED implementation remains challenging. Methods We aimed to increase prescribing of naloxone to ED patients with OUD and opioid overdose by employing a model for improvement methodology, a multi-disciplinary team, and high-reliability interventions. Monthly naloxone prescribing rates among discharged ED patients with opioid overdose and OUD-related diagnoses were tracked over time. Interventions included focused ED staff education on OUD and naloxone, and creation of electronic medical record (EMR)-based work-aids including a naloxone best practice advisory (BPA) and order set. We used autoregressive interrupted time series to model the impact of these interventions on naloxone prescribing rates. The impact of education on ED staff confidence and perceived barriers to prescribing naloxone was measured using a published survey instrument. Results After adjusting for education events and temporal trends, ED naloxone BPA and order set implementation was associated with a significant immediate 21.1% increase in naloxone prescribing rates, which was sustained for one year afterwards. This corresponded to increased average monthly prescribing rates from 1.5% before any intervention to 28.9% afterwards. ED staff education had no measurable impact on prescribing rates, but was associated with increased nursing perceived importance and increased provider confidence in prescribing naloxone. Conclusions We achieved a significant increase in naloxone prescribing rates after implementation of high reliability EMR work-aids and staff education. Similar interventions may be key to wider ED staff engagement in harm reduction for patients with OUD.