TY - JOUR
AU - J. A. Lebin
AU - K. Mitchell
AU - K. E. Trinkley
AU - S. L. Calcaterra
AU - Z. Lun
AU - C. Hensen
AU - J. A. Hoppe
A1 - 
AB - BACKGROUND: Co-prescribing naloxone alongside opioid prescriptions reduces fatal opioid overdose risk in patients discharged from inpatient care, yet its adoption remains limited. Clinical decision support (CDS) tools are effective in increasing naloxone co-prescribing in emergency and primary care settings, but data from the inpatient setting is sparse. OBJECTIVE: To evaluate the effectiveness of an electronic health record (EHR)-integrated CDS tool on rates of naloxone co-prescribing for patients discharged from inpatient care with high-risk opioid prescriptions. DESIGN: This observational, pre-post study evaluated an EHR-embedded CDS tool implemented within an integrated health system between July 10, 2011, and July 15, 2023. STUDY SAMPLE: Adult patients discharged from inpatient care with opioid prescriptions that met the Centers for Disease Control and Prevention high-risk criteria for opioid prescribing. INTERVENTIONS: A multidisciplinary team designed an interruptive CDS best practice alert to identify high-risk opioid prescriptions. The CDS offered prescribers a one-click option to add a naloxone co-prescription. MAIN MEASURES: Outcomes are organized under the RE-AIM implementation science framework, with the primary outcome, Effectiveness, measured by the proportion of patients receiving a naloxone prescription. Secondary outcomes include patient Reach, clinician Adoption, and fidelity to Implementation. Bayesian structural time-series models were used to evaluate differences in outcomes. KEY RESULTS: During the study period, there were 355,465 inpatient discharges. In the post-intervention period, the CDS was triggered in 2.2% (7799/355,465) of all discharges and 6.36% (7799/122,643) of all discharge opioid prescriptions. Compared to the pre-implementation period, CDS was associated with a weekly increase in inpatient naloxone co-prescribing by 4.7 prescriptions per 100 opioid prescriptions (95% CI 4.3-5, p = 0.001). CONCLUSIONS: Implementation of an EHR-embedded CDS was associated with increased naloxone co-prescribing for high-risk opioid prescriptions in the inpatient setting. This finding demonstrates the potential of targeted, interruptive CDS tools to enhance opioid safety efforts in the inpatient setting.
AD - Department of Emergency Medicine, University of Colorado, Aurora, CO, USA. jacob.lebin@cuanschutz.edu.; Department of Emergency Medicine, University of Colorado, Aurora, CO, USA.; Adult and Child Center for Outcomes Research and Delivery Science Center, University of Colorado, Aurora, CO, USA.; Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, USA.; Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA.; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA.
AN - 40721708
BT - J Gen Intern Med
C5 - Opioids & Substance Use
DA - Jul 28
DO - 10.1007/s11606-025-09772-4
DP - NLM
ET - 20250728
JF - J Gen Intern Med
LA - eng
N2 - BACKGROUND: Co-prescribing naloxone alongside opioid prescriptions reduces fatal opioid overdose risk in patients discharged from inpatient care, yet its adoption remains limited. Clinical decision support (CDS) tools are effective in increasing naloxone co-prescribing in emergency and primary care settings, but data from the inpatient setting is sparse. OBJECTIVE: To evaluate the effectiveness of an electronic health record (EHR)-integrated CDS tool on rates of naloxone co-prescribing for patients discharged from inpatient care with high-risk opioid prescriptions. DESIGN: This observational, pre-post study evaluated an EHR-embedded CDS tool implemented within an integrated health system between July 10, 2011, and July 15, 2023. STUDY SAMPLE: Adult patients discharged from inpatient care with opioid prescriptions that met the Centers for Disease Control and Prevention high-risk criteria for opioid prescribing. INTERVENTIONS: A multidisciplinary team designed an interruptive CDS best practice alert to identify high-risk opioid prescriptions. The CDS offered prescribers a one-click option to add a naloxone co-prescription. MAIN MEASURES: Outcomes are organized under the RE-AIM implementation science framework, with the primary outcome, Effectiveness, measured by the proportion of patients receiving a naloxone prescription. Secondary outcomes include patient Reach, clinician Adoption, and fidelity to Implementation. Bayesian structural time-series models were used to evaluate differences in outcomes. KEY RESULTS: During the study period, there were 355,465 inpatient discharges. In the post-intervention period, the CDS was triggered in 2.2% (7799/355,465) of all discharges and 6.36% (7799/122,643) of all discharge opioid prescriptions. Compared to the pre-implementation period, CDS was associated with a weekly increase in inpatient naloxone co-prescribing by 4.7 prescriptions per 100 opioid prescriptions (95% CI 4.3-5, p = 0.001). CONCLUSIONS: Implementation of an EHR-embedded CDS was associated with increased naloxone co-prescribing for high-risk opioid prescriptions in the inpatient setting. This finding demonstrates the potential of targeted, interruptive CDS tools to enhance opioid safety efforts in the inpatient setting.
PY - 2025
SN - 0884-8734 (Print); 0884-8734
ST - Clinical Decision Support to Increase Naloxone Co-prescribing from the Inpatient Setting
T1 - Clinical Decision Support to Increase Naloxone Co-prescribing from the Inpatient Setting
T2 - J Gen Intern Med
TI - Clinical Decision Support to Increase Naloxone Co-prescribing from the Inpatient Setting
U1 - Opioids & Substance Use
U3 - 10.1007/s11606-025-09772-4
VO - 0884-8734 (Print); 0884-8734
Y1 - 2025
ER -