Doctor of Nursing Practice
Susan DeNisco, DNP, APRN, FNP-BC, FAANP
Andy Hernandez MSN, RN
Second Practice Mentor
Dara Richards, MD: Practice Expert
Significance and Background: Opioid overdose is a major public health problem in the United States. The Centers for Disease Control and Prevention (CDC) developed guidelines for prescribing opioids which have not been widely integrated into practice. These guidelines specify co-prescribing naloxone with opioids as a form of harm reduction. A policy to reflect these recommendations was needed to guide prescribing at a Federally Qualified Health Center (FQHC) in Connecticut to increase low naloxone prescribing rates. Evidence supported the use of provider education to increase prescribing rates.
Purpose: Deliver education to providers across the health system on best practices related to prescribing naloxone and to implement a naloxone prescribing policy to reflect these practices. Compare naloxone prescribing rates pre and post provider education.
Methods: Plan-Do-Study-Act. Plan: A naloxone prescribing policy was developed at the FQHC. Educational presentation was developed. Do: An educational session was conducted followed by one-on-one educational sessions. Voiceover presentation and educational materials were disseminated to providers with an additional brief presentation at a provider meeting. Study: Data was gathered on prescribing patterns of naloxone and opioids, as well as co-prescribing rates. Act: Present data to organizational stakeholders.
Outcome: Over the twenty-two-week implementation period, there were a total of 1,125 opioid prescriptions written reflecting a 16% decrease, 260 naloxone prescriptions written indicating a 356% increase, and a total of 55 patients were co-prescribed an opioid with naloxone, representing an increase of 1,275%, almost 14-fold from baseline data. Providers across multiple disciplines, internal medicine, behavioral health, and obstetrics and gynecology prescribed the naloxone prescriptions, with 41% (n=107) of the prescriptions written by providers who received one-on-one education.
Discussion: The implementation of a naloxone prescribing policy disseminated through group and individual educational sessions increased naloxone and co-prescriptions of naloxone with an opioid, while decreasing opioid prescriptions. Educational sessions were geared at stigma reduction as well as identification of overdose risks and ways to normalize naloxone, promoting a therapeutic patient-provider relationship.
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Boback, J. (2023). Naloxone education to improve distribution in primary care: A quality improvement project [Unpublished DNP project]. Sacred Heart University.
Available for download on Wednesday, May 08, 2024
A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.