Evaluating Outcomes of a Resident Driven Naloxone Distribution Initiative

Rates of naloxone co-prescribing with opioids, for reversal of Opioid Induced Respiratory Depression (OIRD) remain low, despite the increased incidence in opioid overdose deaths and the numerous guidelines recommending naloxone prescribing.¹ Coinciding with the COVID-19 pandemic, the Center of Disease Control reported an increase in overdose deaths that involved a prescription opioid after having seen declining rates since 2017.²  The Veterans Affairs (VA) system initiated the Overdose Education and Naloxone Distribution (OEND) dashboard, which can serve as a tool in part, to assist providers in identifying patients who could be appropriate for naloxone prescribing.

Purpose/Objectives:

During the 2022-2023 pharmacy residency year, a resident driven initiative was designed at the Stratton Veterans Affairs Medical Center to increase naloxone distribution rates. Residents used the dashboard to identify patients who could be appropriate for naloxone, then contacted the patient via telephone to provide education and finally, offered the patient naloxone. If the patient was not reached, the resident would leave a chart review note in the electronic medical record, alerting the patient’s primary care provider, to consider offering naloxone at a subsequent follow-up visit.

The purpose of this review is to analyze the outcomes of a resident-driven naloxone distribution and education initiative that was implemented in June 2022.

Method:

This in-progress, single center, retrospective review includes patients who were identified by a pharmacy resident from June 21, 2022 to June 16, 2023, utilizing the OEND dashboard, who could benefit from outreach for naloxone prescribing and education. Information collected includes the number of attempted calls and the rate of naloxone distribution and education. Distribution rates were also examined in instances where the patient was unable to be reached and chart reviews were completed to alert pertinent providers with recommendations to consider naloxone prescribing. At the completion of data collection, analysis will compare outcomes of each method.  Other information collected includes characteristics of an active opioid prescription (if applicable), and if the patient was receiving chronic opioid therapy ( >90 days). The Risk Index for Overdose or Serious Opioid Induced Respiratory Depression (RIOSORD) score was also utilized to determine the patient’s individual OIRD probability.  

Results: A total of 367 encounters were identified. In-progress data collection was completed for 50 encounters, with 42 meeting inclusion criteria. A total of 32 (76%) patients had an active opioid prescription, with 26 (62%) receiving chronic opioid therapy. OIRD probability risk was ≥14% in 35 patients (83%). A total of 24 patients were reached by a pharmacy resident via telephone, with 21 (88%) patients accepting naloxone distribution and education.  There were 18 (43%) patients who were not reached, leading to placement of a chart review note, which resulted in a 22% naloxone prescribing rate.

Conclusions: Preliminary results suggest that a pharmacy resident-driven naloxone clinic resulted in a high rate of acceptance, leading to increased naloxone distribution and education. This shows the impact of incorporating opioid stewardship as a formalized learning experience to trainee education. Initial findings reveal that chart reviews were not as effective in naloxone education and distribution despite residents’ efforts to alert the provider, suggesting that direct contact by pharmacists can play a key role in increasing patient safety and risk mitigation. This in-progress quality improvement project will be further analyzed to identify if initial findings persist.

References: 1. Guy GP. Vital Signs: Pharmacy-Based Naloxone Dispensing — United States, 2012–2018. MMWR Morb Mortal Wkly Rep [Internet]. 2019 [cited
2022 Jul 7];68. Available from: https://www.cdc.gov/mmwr/volumes/68/wr/mm6831e1.htm
2. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2021.