Adult emergency department naloxone education and prescription program: Video and pamphlet education comparison

McElhinny, Megan; Chea, Kimberly; Carter-Powell, Ashley; Mishler, Aimee; Bhattarai, Bikash; Geren, Kara

doi:10.1016/j.jsat.2021.108346

Cited by 4 publications

(3 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is lower than the average 70% to 80% fill rate for medications in general, 25,26 but higher than what other studies have seen for naloxone, with fill rates between 23% and 33%. [27][28][29] Additionally, we have received anecdotal reports from prescribers where their patients have used the naloxone prescribed during an overdose. One patient revived her boyfriend from an overdose, another patient's mother revived him from a fentanyl overdose, and other patients asked for refills because they had used their naloxone on others in their communities or households.…”

Section: Discussionmentioning

confidence: 99%

Assessment of a Naloxone Coprescribing Alert for Patients at Risk of Opioid Overdose: A Quality Improvement Project

Nelson

McCoy

Rector³

et al. 2022

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

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. (Anesth Analg 2022;135:26-34) KEY POINTS• Question: Does identifying patients at risk for opioid overdose using an alert in the electronic health record increase naloxone prescribing? • Findings: Compared to baseline, naloxone coprescribing rates increased from 0.28 (95% confidence interval [CI], 0.24-0.31) to 4.51 (95% CI, 4.33-4.68) naloxone prescriptions per 100 opioid prescriptions after alert implementation, increasing the odds of naloxone coprescribing by approximately 28 times those during the baseline period (95% CI, 15-52). • Meaning: 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. GLOSSARYCDC = Centers for Disease Control and Prevention; CDS = clinical decision support; CI = confidence interval; COVID-19 = coronavirus disease 2019; EHR = electronic health record; IRB = institutional review board; MEDD = morphine equivalent daily dose; OB/GYN = obstetrics and

show abstract

Section: Discussionmentioning

confidence: 99%

Assessment of a Naloxone Coprescribing Alert for Patients at Risk of Opioid Overdose: A Quality Improvement Project

Nelson

McCoy

Rector³

et al. 2022

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

show abstract

“…Illuminating which educational practices can translate training into practice change are important and valuable for improving patient care. Previously published resident curricula focusing on opioid OEND by Monteriro et al [10], Ruff et al [11] and Wakeman et al, [12] chose heavily didactic-style designs, some including panel discussions or small group discussion. In addition, Alford et al, designed OEND curricula featuring the Objective Structured Clinical Exam (OSCE) [13].…”

Section: Resultsmentioning

confidence: 99%

Untitled

2022

ADSD

View full text Add to dashboard Cite

Introduction: Opioid overdose is a preventable cause of death in the United States and timely administration of naloxone, a reversal agent, can be a life-saving intervention. Brief curricular intervention has been shown to improve naloxone prescription rates, and demonstrate improved knowledge among internal medicine residents. Methods:Our study examined the difference in knowledge before and after a 45-minute trivia-based, competitive educational program and assessment on Opioid Overdose and Naloxone Distribution (OEND) practices for eight, specialty-specific didactic sessions. The study's primary outcome was the frequency of resident-issued naloxone prescriptions, measured for two weeks prior to the first training, for two month-long period's concurrent with the trainings and for two weeks following resident trainings. We hypothesized that by providing innovative OEND instruction, naloxone prescription rates and resident knowledge of OEND practices would improve. Results:In six of the seven survey pre-and post-intervention survey questions, residents self-reported statistically significant improvement in knowledge and practice confidence as measured by change in mean response score. Comparison of rate of naloxone prescriptions prior to, during and following curricular implementation did not demonstrate significant change as measured by Chi-square testing. Conclusion:While innovative resident OEND training did correspond with improved resident self-reported knowledge, it did not correspond with a significant change in resident behavior as measured by naloxone prescription rates.

show abstract

“…Interviews were conducted before the Scottish Government's naloxone awareness campaign meaning that there was no specific discussion of this, but videos, pictures or a television campaign were all proposed by patients prescribed opioids for CNCP and family members as potentially helping to illustrate the specifics of naloxone administration. Recent findings from McElhinny et al [31] identified the feasibility of naloxone video education but outlined that more research is required to compare it with knowledge gained from traditional written materials. Nonetheless, video education materials can reduce barriers related to literacy and improve accessibility [32].…”

Section: Discussionmentioning

confidence: 99%

Patient, family members and community pharmacists' views of a proposed overdose prevention intervention delivered in community pharmacies for patients prescribed high‐strength opioids for chronic non‐cancer pain: An explorative intervention development study

Mercer

Parkes

Foster

et al. 2022

Drug and Alcohol Review

View full text Add to dashboard Cite

Introduction: Despite opioid prescribing for chronic non-cancer pain (CNCP) having limited therapeutic benefits, recent evidence indicates significant increases in the prescribing of high-strength opioids for individuals with CNCP. Patients prescribed opioids for CNCP have overdose risk factors but generally have low opioid overdose awareness and low perceptions of risk related to prescribed opioids. Currently, there are few bespoke overdose prevention resources for this group.Methods: This qualitative study investigated views on a naloxone intervention for people prescribed high-strength opioids for CNCP delivered via community pharmacies. The intervention included overdose risk awareness and naloxone training and provision. Interviews were conducted with eight patients, four family members and two community pharmacists. Participants were convenience sampled and recruited through networks within the Scottish pain community. The Framework approach was used to analyse findings.Results: All participants had positive attitudes towards the intervention, but patients and family members considered risk of overdose to be very low. Three themes were identified: potential advantages of the intervention; potential barriers to the intervention; and additional suggestions and feedback about the intervention. Advantages included the intervention providing essential overdose information for CNCP patients. Barriers included resource and time pressures within community pharmacies.Discussion and Conclusion: While patients had low overdose knowledge and did not see themselves as being at risk of opioid overdose, they were receptive to naloxone use and positive about the proposed intervention. A feasibility trial is

show abstract

Adult emergency department naloxone education and prescription program: Video and pamphlet education comparison

Cited by 4 publications

References 15 publications

Assessment of a Naloxone Coprescribing Alert for Patients at Risk of Opioid Overdose: A Quality Improvement Project

Assessment of a Naloxone Coprescribing Alert for Patients at Risk of Opioid Overdose: A Quality Improvement Project

Untitled

Patient, family members and community pharmacists' views of a proposed overdose prevention intervention delivered in community pharmacies for patients prescribed high‐strength opioids for chronic non‐cancer pain: An explorative intervention development study

Contact Info

Product

Resources

About