Implementation of an Electronic Health Record Alert to Improve Naloxone Coprescribing for Adult Patients With Cancer at Risk for Opioid Overdose.

The Centers for Disease Control and Prevention and U.S. Public Health Service recommend that clinicians prioritize coprescribing take-home naloxone (THN) for patients with cancer receiving opioids in high doses or in the presence of a concomitant high-risk medication. Despite this, THN coprescribing rates remain low. The aim of this quality improvement project (QIP) was to determine if the implementation of an electronic health record (EHR) alert could result in increased THN coprescribing rates in patients with cancer at risk for opioid overdose. This pre- and post-intervention QIP was conducted in an outpatient medical oncology clinic in the Mountain West region of the US. Opioid prescriptions for the management of cancer-related pain totaling ≥ 100 morphine milligram equivalents (MME) per day or with a concomitant high-risk medication were eligible for inclusion (N = 224). An EHR alert was developed to notify the provider when eligibility criteria were met, prompting them to coprescribe THN. The primary outcome measure to increase THN coprescribing rates for opioid prescriptions totaling ≥ 100 MME per day was 38% at the end of the post-intervention period, a 29 percentage point increase from baseline (odds ratio [OR] = 6.57, 95% confidence interval [CI] = 1.85-23.39, p = .003). The coprescribing rate for opioid prescriptions with a high-risk medication was 57% at completion of the project, a 53 percentage point increase from baseline (OR = 30.67, 95% CI = 8.91-105.59, p < .001). This project established the practicality and success of THN coprescribing alert implementation and can be utilized as a roadmap for other practices to achieve safe opioid prescribing for patients with cancer.