• Stephanie P Van, Ada Lyn Yao, Teresa Tang, Margaret Kott, Amira Noles, Nicholas Dabai, Alexis Coslick, Solomon Rojhani, Lee Ann Sprankle, and Erik H Hoyer.
• Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD.
• Arch Phys Med Rehabil. 2019 Aug 1; 100 (8): 1391-1399.

ObjectiveTo describe the implementation and evaluation of an interdisciplinary quality improvement (QI) project to increase prescription of take-home naloxone (THN) to reduce risks associated with opioids for patients admitted to an acute inpatient rehabilitation unit.DesignProspective cohort quality improvement project.SettingEighteen-bed acute comprehensive inpatient rehabilitation (ACIR) unit at a large academic institution.ParticipantsPatients admitted to ACIR between December 2015-November 2016 (N=788).InterventionsAn interdisciplinary QI model comprised of planning, education, implementation, and maintenance was used to implement a THN and opioid risk-reduction program involving provider and patient education. Analyses consisted of comparisons between baseline, early, and late phases of the project.Main Outcome Measures(1) The proportion of eligible patients who received a prescription for naloxone upon discharge from ACIR; (2) the proportion of patients originally admitted to ACIR on opioids that were weaned off upon discharge.ResultsThe adjusted odds of eligible patients being discharged from ACIR with a naloxone prescription during the late QI period were 7 (95% confidence interval [CI]: 3-21) times higher than during the early QI period (late QI period: 43%, 95% CI: 25%-63%; early QI period: 10%, 95% CI: 3%-28%; P<.001). For patients admitted on opioids, the adjusted odds of being weaned off opioids during the late QI period were 10 (95% CI: 4-25) times higher than during baseline (late QI period: 29%, 95% CI: 17%-45%; baseline: 4%, 95% CI: 1%-10%; P<.001).ConclusionsImplementation of a THN and opioid risk reduction QI project in an inpatient rehabilitation setting led to significantly more eligible patients receiving naloxone and more patients weaned off schedule II opioids.Copyright © 2019 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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