BACKGROUND: 

Patients taking high doses of opioids, or taking opioids in combination with other central nervous system depressants, are at increased risk of opioid overdose. Coprescribing the opioid-reversal agent naloxone is an essential safety measure, recommended by the surgeon general, but the rate of naloxone coprescribing is low. Therefore, we set out to determine whether a targeted clinical decision support alert could increase the rate of naloxone coprescribing.

METHODS: 

We conducted a before-after study from January 2019 to April 2021 at a large academic health system in the Southeast. We developed a targeted point of care decision support notification in the electronic health record to suggest ordering naloxone for patients who have a high risk of opioid overdose based on a high morphine equivalent daily dose (MEDD) ≥90 mg, concomitant benzodiazepine prescription, or a history of opioid use disorder or opioid overdose. We measured the rate of outpatient naloxone prescribing as our primary measure. A multivariable logistic regression model with robust variance to adjust for prescriptions within the same prescriber was implemented to estimate the association between alerts and naloxone coprescribing.

RESULTS: 

The baseline naloxone coprescribing rate in 2019 was 0.28 (95% confidence interval [CI], 0.24–0.31) naloxone prescriptions per 100 opioid prescriptions. After alert implementation, the naloxone coprescribing rate increased to 4.51 (95% CI, 4.33–4.68) naloxone prescriptions per 100 opioid prescriptions (P < .001). The adjusted odds of naloxone coprescribing after alert implementation were approximately 28 times those during the baseline period (95% CI, 15–52).

CONCLUSIONS: 

A targeted decision support alert for patients at risk for opioid overdose significantly increased the rate of naloxone coprescribing and was relatively easy to build.

中文翻译：

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针对有阿片类药物过量风险的患者的纳洛酮联合处方警报评估：质量改进项目

背景： 

服用高剂量阿片类药物或与其他中枢神经系统抑制剂联合服用阿片类药物的患者，阿片类药物过量的风险增加。联合处方阿片类药物逆转剂纳洛酮是外科医师推荐的一项重要安全措施，但纳洛酮联合处方率较低。因此，我们着手确定有针对性的临床决策支持警报是否可以提高纳洛酮联合处方率。

方法： 

我们于 2019 年 1 月至 2021 年 4 月在东南部的一个大型学术卫生系统进行了一项前后研究。我们在电子健康记录中制定了有针对性的护理点决策支持通知，建议根据高吗啡当量日剂量 (MEDD) ≥90 mg、同时服用苯二氮卓类处方或阿片类药物过量高风险的患者订购纳洛酮。阿片类药物使用障碍或阿片类药物过量史。我们测量了门诊纳洛酮处方率作为我们的主要指标。采用具有稳健方差的多变量逻辑回归模型来调整同一处方者内的处方，以估计警报与纳洛酮共同处方之间的关联。

结果： 

2019 年基线纳洛酮共同处方率为每 100 张阿片类药物处方 0.28 个（95% 置信区间 [CI]，0.24-0.31）个纳洛酮处方。实施警报后，纳洛酮共同处方率增至每 100 张阿片类药物处方 4.51 个（95% CI，4.33-4.68）个纳洛酮处方（P < .001）。警报实施后，纳洛酮联合处方的调整后赔率约为基线期间的 28 倍（95% CI，15-52）。

结论： 

针对阿片类药物过量风险患者的有针对性的决策支持警报显着提高了纳洛酮联合处方的比例，并且相对容易建立。