The effectiveness of a noninterruptive alert to increase prescription of take-home naloxone in emergency departments

Abstract

Objective Opioid-related overdose (OD) deaths continue to increase. Take-home naloxone (THN), after treatment for an OD in an emergency department (ED), is a recommended but under-utilized practice. To promote THN prescription, we developed a noninterruptive decision support intervention that combined a detailed OD documentation template with a reminder to use the template that is automatically inserted into a provider’s note by decision rules. We studied the impact of the combined intervention on THN prescribing in a longitudinal observational study. Methods ED encounters involving an OD were reviewed before and after implementation of the reminder embedded in the physicians' note to use an advanced OD documentation template for changes in: (1) use of the template and (2) prescription of THN. Chi square tests and interrupted time series analyses were used to assess the impact. Usability and satisfaction were measured using the System Usability Scale (SUS) and the Net Promoter Score. Results In 736 OD cases defined by International Classification of Disease version 10 diagnosis codes (247 prereminder and 489 postreminder), the documentation template was used in 0.0% and 21.3%, respectively (P < .0001). The sensitivity and specificity of the reminder for OD cases were 95.9% and 99.8%, respectively. Use of the documentation template led to twice the rate of prescribing of THN (25.7% vs 50.0%, P < .001). Of 19 providers responding to the survey, 74% of SUS responses were in the good-to-excellent range and 53% of providers were Net Promoters. Conclusions A noninterruptive decision support intervention was associated with higher THN prescribing in a pre-post study across a multiinstitution health system.

The role of information systems in emergency department decision-making—a literature review

“…Four studies improved naloxone prescription for opioid-related overdose. 51 , 60 , 100 , 101 Griffey et al 54 and Terrell et al 102 reduced inappropriate medication for elderly patients. Two studies increased ketorolac prescribing 103 or decreased excessive dosing 104 in renal impairment.…”

“…Most analyzed IS are integrated into the medication or imaging ordering systems. 51 , 86 Future research could explore methods to maintain this workflow integration when clinicians are away from their workstations, potentially through wearables or augmented reality. Ensuring that only the most important information is relayed through these devices, future research should prevent sensory overflow and integrate rest periods away from the PC for recovery.…”

Opioid Prescribing for Chronic Musculoskeletal Conditions: Trends over Time and Implementation of Safe Opioid-Prescribing Practices

“…Overall, it seems CDS interventions are often effective in improving behaviors, like prescribing naloxone, using urine drug screenings, and prescribing for a short duration, but not necessarily for other prescribing outcomes such as MME. 29,[32][33][34][35][36][37][38]…”

Enhanced phenotypes for identifying opioid overdose in emergency department visit electronic health record data

“…Models that use clinical data available in nearly real-time can also be applied to drive decision support tools within the visit, such as prompting for additional data on the overdose cause, planning for follow up care, initiating medications for patients with opioid use disorder, or prescribing take home naloxone. 6 Examples of clinical data that are available within a visit include emergency department chief complaints, triage nursing notes, administration and response to antidotes (eg, naloxone), vital signs, and laboratory results such as drug screening testing. In addition, baseline data from prior to a visit, such as ICD-10-CM diagnostic codes from prior emergency department visits or from outpatient care may also be useful.…”