For a year, Nebraska Medicine has been leading an effort to boost prescriptions of naloxone across its health system. Since then, monthly naloxone dispenses statewide have risen more than three times on average, new Epic data show.
In the five months leading up to the initiative launch in August 2021, the number of naloxone prescriptions written at Nebraska Medicine was 145 total. In the subsequent five months, that jumped to 3,200. Meanwhile, statewide naloxone dispenses rose from an average of 152 a month in the prior five months to an average of 640 a month in the following five months.
From August through December 2020, the average number of prescriptions at the health system was around 145 a month. The following year, when the initiative was implemented, the monthly average jumped to 500 or more. The data were revealed in a post on EpicShare, a platform run by the EHR company for healthcare executives to share their IT experiences.
It is well established that naloxone rapidly reverses an opioid overdose. But despite it being recommended in practice by the Centers for Disease Control and Prevention, few patients are prescribed it. The post cited one study in Nebraska that estimated only 15% of residents knew where to obtain it, and fewer than a quarter knew how to use it.
Omaha-based Nebraska Medicine wanted to educate providers on naloxone benefits and the risks associated with opioid dependence. A pain medicine stewardship pharmacist and an addiction psychiatrist teamed up to design prescribing guidelines and worked with the IT team to also build a feature to complement the effort within Epic. They used a blueprint of Epic’s Foundation System, which outlines workflows and customizable options, to design a best practice advisory in the EHR.
When Nebraska Medicine providers now prescribe opioids, they are prompted to also prescribe naloxone. The move was rolled out all at once across the system, and was approved by the pain steering committee, the physicians’ advisory council, a decision support advisory team and a voting body. The prompt also offers providers language to use with patients that is clear and non-stigmatizing.
“We want to flood the community with naloxone,” the addiction psychiatrist, Alëna Balasanova, M.D., said in the post. “I think of it like a fire extinguisher. You want to have it in your house just in case something should ever happen. You don’t ever expect to use it, nor do you want to use it. But gosh, if you end up having a fire, aren’t you glad you have that fire extinguisher?”
The team also provided resources like links to relevant studies for further education and personally went over any concerns with providers. Now, the health system is looking to implement an initiative to give out naloxone to patients discharged from the emergency department with an opioid overdose as well as to hand out medication bags for patients to use to dispose of unused opioid medications.