Naloxone coprescribing best practice advisory for patients at high risk for opioid-related adverse events
DOI:
https://doi.org/10.5055/jom.0866Keywords:
naloxone coprescribing, best practice advisory, opioid-related adverse events, harm reduction, clinical decision support, morphine milligram equivalent, morphine equivalents daily doseAbstract
Objective: To implement an electronic health record best practice advisory (BPA) to promote coprescribing of naloxone to patients at high risk of serious opioid-related adverse events (ORADEs).
Design: This pre–post quasi-experimental study evaluated 9 months of opioid and naloxone prescription data before and after BPA implementation.
Setting: The Froedtert & the Medical College of Wisconsin enterprise is comprised of 45 ambulatory clinics and 10 hospitals, including the only adult Level 1 trauma center in eastern Wisconsin.
Patients: Patients who received opioid prescriptions in the preimplementation time period (n = 106,615 prescriptions) and post-implementation time period (n = 107,352 prescriptions) were included.
Interventions: BPA activation criteria included entry of a prescription with a morphine equivalent daily dose of 50 or greater with at least a 5-day supply, concomitant opioid and benzodiazepine prescription, or opioid prescription entry for a patient with a documented history of opioid overdose. The BPA defaulted to coprescribe naloxone, while also providing suppression options.
Main outcome measure: The primary endpoint was the change in naloxone prescription rate for patients on chronic opioid therapy (COT) with a morphine milligram equivalent daily dose (MEDD) per day of 50 or greater.
Results: The naloxone coprescription rate for COT patients with a MEDD of 50 or greater increased from 12.2 percent (95 percent confidence interval [CI] 10.4-14.4) to 34.79 percent (95 percent CI 31.8-38.2) after the BPA was implemented (odds ratio 2.85, 95 percent CI 2.37-3.42, p-value < 0.001).
Conclusions: Use of BPA increased the rate of naloxone coprescribing for patients at risk of serious ORADE.
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