Scientific Poster Session IV - Encore

Abstract

The opioid epidemic continues to be a crisis in the United States taking thousands of lives each year with deaths increasing significantly in 2020. Studies have shown that doses of 50 to <100 morphine milligram equivalents (MME) per day are associated with an approximately 2.6 times increased risk of death.

In 2020, Minnesota Legislature passed a law allowing pharmacists to independently prescribe opioid antagonists through a protocol developed by the Minnesota Board of Pharmacy. This is a unique opportunity for hospital pharmacists to participate in combating the opioid epidemic by prescribing naloxone and providing education prior to discharge. Our observed gap in quality is the lack of patients with access to an opioid antagonist (naloxone) on discharge in the internal medicine patient population taking high dose chronic opioids. The aim of this project is to develop a procedure for inpatient pharmacists to independently prescribe naloxone at hospital discharge to improve drug access.

The project completion date is June 2022, and the goal is to capture at least 50% of patients that are at high-risk and offer them a naloxone prescription.

Measure:

In our pre-intervention analysis, we reviewed a 6 month time period in which 52 patients met the designated criteria. Of the chronic opioid users who were included, only 3 patients (5.8%) were prescribed naloxone at discharge. Based off this information, we were hoping to capture 30-40 patients in our 3 month intervention pilot.

Analyze:

Potential causes contributing to the gap in quality include lack of a formal screening and education process for inpatient providers and pharmacists. Naloxone prescribing may also be perceived to be an outpatient task and be time consuming.

Improve:

This was a single-enterprise, dual-institution quality improvement project involving internal medicine patients admitted to either St. Mary’s Hospital - Rochester or Mayo Clinic Health System - Mankato. The primary outcome was assessing the number of hospitalized chronic opioid patients with naloxone prescriptions on discharge. Patients were included if they were chronic opioid users on = 50 MME daily. The project intervention entailed creating and providing education to pharmacists to meet prescribing requirements as well as updating patient education documents to align with the Board of Pharmacy protocol.

After our 3 month pilot project, 40 patients were identified to be high-risk chronic opioid users eligible to be prescribed naloxone. Of these 40 patients, pharmacists attempted to prescribe naloxone for 28 patients, and of those, 22 were successfully prescribed naloxone (55%) which was much improved in comparison to the 5.8% success rate in the pre-intervention findings.

Control:

We identified that pharmacists were able to improve naloxone accessibility by educating patients who were at high risk and prescribing them naloxone through the laws set forth by Minnesota Legislature.

Relevance:

Next steps include evaluation of expanding pharmacist prescribing hospital wide to capture a greater number of high risk patients being prescribed opioids at Mayo Clinic Rochester. Additionally, pending specific state laws, the hope would be to implement this enterprise wide.

Presenting Author

Authors