11 Improving intervention use for opioid overdose through emergency department electronic medical record work-aids

Background Emergency Department (ED) visits for opioid overdose continue to rise. Our global aim is to implement evidence-based harm reduction practices in our large, academic ED, such as facilitating naloxone prescribing through the electronic medical record (EMR) and disseminating resources for outpatient treatment. Objectives Increase the provision of naloxone prescriptions and community resources to patients at high-risk of opioid overdose upon ED discharge. Methods To increase naloxone prescribing and provision of community resources to high-risk patients, a model for improvement methodology, a multi-disciplinary team, and prioritization of high-reliability interventions were used. Key drivers and interventions included: didactic lectures to providers, collation of community resources, real-time patient identification through a best practice advisory (BPA) in the EMR, prescriber order sets, and defaulting desired patient education materials (figure 1). Rates of naloxone prescribing and BPA-triggered order set use were tracked over time on statistical control charts (p-charts). Results The average proportion of high-risk patients who received naloxone prescriptions increased from a baseline of 1.9% to 6.6% after didactic education sessions, and 21.7% after implementation of EMR-based interventions (8 points above centerline, respectively) (figure 2). Since its implementation, 16% of fired BPAs resulted in naloxone order set activation (monthly range: 9–25%). Conclusions Our findings support that some emergency department providers are willing to prescribe naloxone to patients at risk for opioid overdose, and that prescribing is influenced by highly reliable work-aids built into EMR systems. The spread of similar technology to other care settings may be key to wider provider engagement in mitigating morbidity from opioid overdose.