• Erica Heiman, Sothivin Lanh, Tim P Moran, Alaina Steck, and Joseph Carpenter.
• Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. erica.heiman@yale.edu.
• J Gen Intern Med. 2023 May 1; 38 (6): 140214091402-1409.

BackgroundNaloxone is a life-saving, yet underprescribed, medication that is recommended to be provided to patients at high risk of opioid overdose.ObjectiveWe set out to evaluate the changes in prescriber practices due to the use of an electronic health record (EHR) advisory that prompted opioid prescribers to co-prescribe naloxone when prescribing a high-dose opioid. It also provided prescribers with guidance on decreasing opioid doses for safety.DesignThis was a retrospective chart abstraction study looking at all opioid prescriptions and all naloxone prescriptions written as emergency department (ED) discharge, inpatient hospital discharge, or outpatient medications, between July 1, 2018, and February 1, 2020. The EHR advisory went live on June 1, 2019.SubjectsIncluded in the analysis were all adult patients seen in the abovementioned settings at a large county hospital and associated outpatient clinics.Main MeasuresWe performed an interrupted time series analysis looking at naloxone prescriptions and daily opioid dosing in morphine milligram equivalents (MMEs), before and after initiation of the EHR advisory.Key ResultsThe EHR advisory was associated with changes in prescribers' behavior, leading to increased naloxone prescriptions and decreased prescribed opioid doses.ConclusionsEHR advisories are an effective systems-level intervention to enhance the safety of prescribed opioids and increase rates of naloxone prescribing.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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