(1213) Opioid Overdose Risk Screening Tool Implementation in the ED to Promote Naloxone Distribution

Introduction: Opioid overdoses continue to rise nationally. One effective mitigation strategy is to increase access to take-home naloxone in the emergency department (ED). The Department of Health Services provided our ED with naloxone to distribute. Despite pharmacists using a standing order to distribute naloxone, operationalization of this process proved a challenge; high-risk patients were difficult to identify in real-time. To maximize distribution, a screening tool was developed and embedded within the electronic health record to identify patients at high-risk. The goal was to measure the association between screening tool implementation and naloxone distribution.

Methods: A quasi-experimental evaluation comparing naloxone distribution 8 months pre- (Mar-Oct 2022) and post-implementation (Nov 2022-Jun 2023) of the screening tool was conducted in the ED at a large academic medical center. Upon presentation to the ED, the screening tool identified patients as high-risk for opioid overdose if they satisfied any of the following criteria: opioid-related ED encounter (primary or secondary ICD10 code of F11* or T40*), illicit opioid use, prior opioid overdose, high-dose opioid prescription, or opioid/benzodiazepine co-prescription. Each criteria was worth one point (max score 5); the sum of all criteria displayed for the ED pharmacist who screened patients as part of their daily responsibilities. Any high-risk patient discharged from the ED was eligible to receive a naloxone kit. The primary outcome was the frequency of naloxone distribution per 100 opioid-related ED encounters.

Results: During the study period there were 101,658 ED encounters, of which 1,504 were opioid-related (778 pre and 726 post). The median risk score was 2 (IQR 1-3); the most common criteria was illicit opioid use. A total of 12 patients were distributed naloxone kits before the intervention, and 37 after. The rate of naloxone distributions increased from 1.54 to 3.72 kits per 100 opioid-related ED encounters in the pre- and post-implementation groups, respectively (p < 0.001).

Conclusions: With an established naloxone standing order allowing pharmacists to autonomously distribute naloxone, the addition of a screening tool to identify patients at high-risk of an opioid overdose was associated with an increase in naloxone distribution.