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February 21, 2019 (Cleveland)

Hospital Naloxone Co-Prescribing Intervention Demonstrates Success



Opioid Consortium Members Gather for First Joint MeetingOne local health system has found substantial benefit from an intervention designed to improve naloxone co-prescribing for patients who are prescribed opioids. The MetroHealth System’s Associate Chief Medical Informatics Officer Jonathan Siff, MD, MBA, FACEP, FAMIA, shared the results of the system’s new initiative at the February meeting of the Northeast Ohio Hospital Opioid Consortium.

In March 2018, MetroHealth implemented an intervention in the electronic health record that reminds providers to prescribe naloxone. It is triggered when a provider signs an order of an ambulatory opioid medication, including at hospital discharge, or an order for a benzodiazepine for a patient already prescribed opioids.

MetroHealth was thoughtful in designing the alert, which notifies providers before completion of the order and does not fire if a patient has an active naloxone prescription.

“We wanted to make it easy to do the right thing,” said Dr. Siff. “An intervention should target the right people and come at the right time.” And in fact, data collected for nine months prior to implementation compared to data collected in the nine months following implementation demonstrate the naloxone co-prescribing intervention has been highly effective.

Prior to implementation, 322, or 0.33 percent, of all opioids had a naloxone prescription. This increased to more than 8,100 or 40 percent of all opioid prescriptions during the nine months post-implementation, and 71 percent of all prescriptions with a morphine-equivalent dose (MED) of more than 50.

In situations where naloxone is not co-prescribed with an opioid, MetroHealth is collecting information to understand why and to further hone their tool. One challenge all providers face in naloxone co-prescribing is that some patients decline it, an experience MetroHealth providers have encountered with some patients.

A goal of the Opioid Consortium that is currently underway is improving public and patient education. The objective is helping patients to be informed about their opioid medications as well as the use and importance of naloxone.

MORE: For more information about the Northeast Ohio Hospital Opioid Consortium, contact us.

TWEETABLE: According to @neohospitals, naloxone co-prescribing increased 2,500% after @MetroHealthCLE implemented an EHR alert. #OpioidConsortium