A Multi-faceted Intervention to Improve Naloxone Co-Prescription Rates Among Primary Care Providers

It is estimated that 91 Americans die every day due to opioid overdoses, with at least half of those overdoses involving an opioid prescription (CDC, 2016d). To address this issue, the U.S. Department of Health and Human Services (USDHHS) has initiated an opioid initiative, and the Centers for Disease Control and Prevention (CDC) has released a clinical guideline, both of which include a focus on increasing use of naloxone. Despite these recommendations, providers often fail to co-prescribe naloxone to patients at increased risk of opioid overdose. The purpose of this evidence-based practice (EBP) project was to evaluate the effect of a multi faceted intervention (including the use of academic detailing sessions, provider reminders, and a clinical champion) to increase naloxone co-prescription rates within an Indian Health Services Tribal Health Department in the Midwestern United States. The Iowa Model of Evidence-based Practice and Kotter’s Change Model were used to guide this project, which was supported by 10 pieces of evidence obtained through a systematic search of the literature. Retrospective chart audits were conducted on patients receiving opioid prescriptions of 30 days or greater during the 12-week intervention period and the same time period in 2016. Descriptive statistics were used to compare the frequency of naloxone co-prescriptions pre-intervention (0 of 48 eligible patients; 0%) and post-intervention (10 of 40 eligible patients; 25%). The 25-percentage point increase in co-prescribing was consistent with the supportive evidence and reflected a statistically significant association between the multi-faceted intervention and naloxone co- prescription distribution (X2 = 13.538,