Supporto alle decisioni cliniche per migliorare il sistema di co-prescrizione di naloxone

Encounters where the naloxone clinical decision support (CDS) alert fired. CDS logic is programmed to fire alert when a provider places and order for a high-risk opioid analgesic prescription to a patient without an active naloxone prescription.

High-risk prescription logic to trigger the Naloxone CDS:

[(NOT 1 AND (2 AND AT LEAST 1 OF (3, 4, 5, 6))) AND 7 AND NOT 8]

1. ACTIVE OR PENDED NALOXONE PRESCRIPTION ORDER
2. OPIOID SCRIPT BEING PLACED CRITERIA
3. DAILY Milligram Morphine Equivalent (MME) >=90 UNSIGNED ORDER
4. DAILY MME >=90 EXISTING
5. DIAGNOSIS OF OPIOID USE DISORDER
6. DIAGNOSIS HISTORY OF OPIOID OVERDOSE
7. PROVIDER LOGGED INTO ELLIGIBLE DEPARTMENTS
8. DISCHARGE TO HOSPICE

Clinical decision support in the form of an EHR-integrated, provider facing alert suggesting (a) the opioid medication order is considered high risk for overdose and (b) to nudge providers to add a naloxone prescription to the opioid prescription to mitigate risk in the event of an overdose.

Control group of contemporary encounters where clinical decision support (CDS) is not active. Usual care.

The number of high-risk opioid encounters where a naloxone prescription was written with the opioid divided by the total number of encounters where a high-risk opioid prescription was written.

The number of times providers accepted the Clinical decision support (CDS) suggestion and co-prescribed naloxone with a high-risk opioid divided by the total number of times a high-risk opioid prescription triggered the CDS alert.

The number of patients who had a diagnosis of opioid overdose or poisoning in the six months following the index visit with a high-risk opioid prescribed.

The number of patients who were dispensed a naloxone prescription divided by the number of naloxone prescriptions written.