# Improving Naloxone Co-prescribing Through Clinical Decision Support

## TL;DR

A clinical decision support tool significantly increased naloxone co-prescribing rates with high-risk opioid prescriptions in outpatient clinics.

## Contribution

Demonstrates that a CDS alert system effectively improves adherence to naloxone co-prescription guidelines in real-world clinical settings.

## Key findings

- Naloxone co-prescribing rates rose from 1.1% to 9.4% after implementing the CDS tool.
- The increase was observed across eight family medicine and internal medicine clinics.
- The CDS tool was easy to implement and had a statistically significant impact (p<0.001).

## Abstract

Background: Despite national guidelines recommending naloxone co-prescription with high-risk medications, rates remain low nationally. This was reflected at our institution with remarkably low naloxone prescribing rates. We sought to determine if a clinical decision support (CDS) tool could increase rates of naloxone co-prescribing with high-risk prescriptions.

Methods: An alert in the electronic health record was triggered upon signing an order for a high-risk opioid medication without a naloxone co-prescription. We examined all opioid prescriptions written by family and general internal medicine practitioners at the University of Iowa Hospitals and Clinics in outpatient encounters between November 30, 2020, and February 28, 2022. Once triggered by a high-risk prescription, the CDS tool had the option to choose an order set with an automatically selected co-prescription for naloxone along with patient instructions automatically added to the patient's after-visit summary (AVS). We examined the monthly percentage of patients receiving Schedule II opioid prescriptions ≥90 morphine milliequivalents (MME)/day who received concurrent naloxone prescriptions in the 12 months before the CDS went live and the three months following go-live.

Results: Concurrent naloxone prescriptions increased from 1.1% in the 12 months prior to implementation in November 2021 to 9.4% (p<0.001) during the post-intervention period across eight family medicine and internal medicine clinics.

Discussion: This single-center quality improvement project with retrospective analysis demonstrates the potential efficacy of a single CDS tool in increasing the rate of naloxone prescription. The impact of such prescribing on overall mortality requires further research.

Conclusions: The CDS tool was easy to implement and improved rates of appropriate naloxone co-prescribing.