O2117: Naloxone Distribution Program

Purpose/Objectives: In 2016, pediatric deaths related to opioid overdose had increased since 1999 by 268%, with 12% of all deaths in the population of 15-24 year old individuals. In 2023, 2,451 cases of suspected drug overdose in patients under seventeen were reported in Arizona hospitals. Despite this data, there has been little research published exploring the implementation and success of a naloxone distribution program in pediatric hospitals.

This Naloxone Distribution Program (NDP) will demonstrate feasibility and effectiveness of an electronic screening process for risk of opioid associated life threatening emergency (OALTE) and promote safe and equitable distribution of take-home intranasal naloxone kits with associated patient education, appropriate hospital and community resources. Our aim is to offer Naloxone intranasal kits and associated materials to 70% of patients/legally authorized representatives identified as high risk of OALTE within a six month pilot period (February to July 2024).

Design/Methods: Patients are identified as either High Risk (Red) or Possible Risk (Yellow) by the algorithm. All eligible patients/legally authorized representatives (LAR) will be offered naloxone if they trigger the alert, but those who are Possible Risk will have an additional evidence based screening questionnaire to identify substance abuse concerns, risk-stratify, and guide appropriate outpatient resources.

If the patient and/or LAR assents to receive a naloxone take-home kit, they will be provided with a 2-pack 4 mg naloxone intranasal spray kit, instructions on administration of the medication, and outpatient resources through a social work consult.

Outcome Measures:
- Percentage of patients triggering Opioid Risk alert in EHR who were offered naloxone (Naloxone THKs offered/number of eligible patients) - see Run Chart 1.
- Number of kits distributed/week

Process Measures:
- CRAFFT Note Completion
> % of Possible/Yellow Opioid Risk alert patients (excluding NA) who had completed Opioid Risk/CRAFFT Screening Note.
- Omnicell Distribution
> % of Patients with Naloxone OTC Kit Order placed who had Omnicell Distribution

Results: In a six-month pre-intervention period, an earlier version of our alert criteria yielded 36 patients that would have triggered the alert. Additionally, ICD codes denoting opioid use disorders (n= 6) and patients who had an order for naloxone administered in the ED during the same period (n=5) were identified. During that time, 26 prescriptions were provided for naloxone, suggesting only 55% of possibly eligible patients were offered naloxone (26/47).

During the one month since the NDP Go Live, 36 kits have been distributed to patients at risk of OALTE, indicating a swift improvement even in the short time since the screening tool has gone live.

Conclusion/Discussion: The preliminary results of this project indicate that with further implementation of the screening process and provider education, a dramatic improvement may be seen in naloxone distribution to patients at risk of OALTE.