Effect of a best practice advisory activated "kit in hand" naloxone distribution program in the emergency department.

Purpose: We implemented a "kit in hand" naloxone distribution program at emergency department (ED) discharge activated by electronic health record Best Practice Advisory (BPA). The purpose of this study was to evaluate naloxone kit distribution before and after implementation.

Methods: Retrospective observational study of adult ED patients with unintentional opioid overdose conducted over a six-month period. An intranasal (IN) naloxone kit in hand distribution program activated by BPA was implemented during the study period. Patient demographics and reasons eligible patients did not receive a kit are reported. Multivariable regression was performed to identify differences in patients that received naloxone or were intended to receive it compared to those that were not to identify any biases in distribution.

Results: A total of 349 patients were included; 160 pre- (median age 39.5 years, 74.4 % males, 63.1 % white, 83.7 % non-Hispanic) and 189 post-implementation (median age 41 years, 75.7 % males, 52.9 % white, 81.5 % non-Hispanic). Pre-implementation, 109/160 (68.1 %) patients received a naloxone prescription at discharge with only 25/109 (22.9 %) confirmed to have picked up the naloxone kit and therefore a total of 25/160 (15.6 %) receiving naloxone. Post-implementation, 106/189 (56.1 %) patients left the ED with a naloxone kit in hand and 1/22 additional patients that had a prescription written were confirmed to have picked it up; therefore, a total of 107/189 (56.6 %) receiving naloxone. Reasons for not receiving a naloxone kit in the post-implementation period were patient refusal (6.3 %), patient already had naloxone (1.6 %), or a prescription was written instead (11.6 %). There were instances where kits were intended to be ordered based on clinician notes or naloxone kit was ordered but not dispensed by nursing staff. There were no differences between age, sex, race, ethnicity, or time of discharge from the ED following comparison of those where the clinician intended for the patient to receive naloxone and those where there was not intent to prescribe naloxone in the post-implementation group.

Conclusions: Implementation of a BPA-activated kit in hand naloxone distribution program increases the rate of successful naloxone distribution to patients presenting to the ED following unintentional opioid overdose, a subpopulation at very high risk for recurrence of overdose. Opportunities for program improvement were identified as there were instances where kits were intended to be distributed but barriers in the process existed.