Point-of-Care Naloxone Distribution in the ED Increases Provider Prescription Rate

Abstract

Background: Distribution of naloxone rescue kits has been found to be safe, reduce death rate from overdose, and be associated with a decrease in high-risk opioid use A rural emergency department (ED) developed an intervention to increase provision of naloxone rescue kits to patients at risk of opioid overdose. Methods: Naloxone rescue kits were stocked in the ED Omnicell. An order set was created in the electronic medical record (EMR) consolidating order for rescue kit and referral to substance abuse treatment center. ED providers were given an educational session to demonstrate the effectiveness of naloxone rescue kits and the new care plan. A retrospective review of 12-month periods pre- and post-intervention was completed. Patients at risk of opioid overdose were identified by diagnosis or provider judgement. Primary outcome was order for rescue kit provision at time of discharge. Secondary outcomes included buprenorphine order in ED, referral to substance abuse treatment center, and attendance of 7-day post-discharge follow-up encounter. Analysis performed with chi-square test and a p value of <0.05 was considered significant. Results: Rate of naloxone rescue kit order rose from 1.6% to 10.4% ( p = 0.0025). Rate of buprenorphine ordering rose from 14.2% to 31.3% ( p = 0.0007). Referrals to outpatient treatment did not differ (12.6% versus 19.6%; p = 0.1). Attendance of 7-day follow-up encounter decreased (24.5% versus 46.5%; p = 0.0001). Conclusions: This intervention modestly increased the provision of naloxone rescue kits in one ED. Future work should focus on care coordination with outpatient clinics to improve the follow-up rate.