Rittel Alexander G, Highland Krista B, Maneval Mark S, Bockhorst Archie D, Moreno Agustin, Sim Alan, Easter Peter S, Nichols Chris E, Costantino Ryan C
Enterprise Intelligence and Data Solutions (EIDS) program office, Program Executive Office, Defense Healthcare Management Systems (PEO DHMS), San Antonio, TX,USA.
Defense & Veterans Center for Integrative Pain Management, and Department of Anesthesiology, Uniformed Services University, Bethesda, MD,USA.
Am J Health Syst Pharm. 2022 Jan 1;79(1):e58-e64. doi: 10.1093/ajhp/zxab206.
To describe the development, implementation, and evaluation of a pharmacy clinical decision support tool designed to increase naloxone coprescription among people at risk for opioid overdose in a large healthcare system.
The Military Health System Opioid Registry and underlying presentation layer were used to develop a clinical decision support capability to improve naloxone coprescription at the pharmacy point of care. Pharmacy personnel use a patient identification card barcode scanner or manually enter a patient's identification number to quickly visualize information on a patient's risk for opioid overdose and medical history related to pain and, when appropriate, receive a recommendation to coprescribe naloxone. The tool was made available to military treatment facility pharmacy locations. An interactive dashboard was developed to support monitoring, utilization, and impact on naloxone coprescription to patients at risk for opioid overdose.
Initial implementation of the naloxone tool was slow from a lack of end-user awareness. Efforts to increase utilization were, in part, successful owing to a number of enterprise-wide educational initiatives. In early 2020, the naloxone tool was used in 15% of all opioid prescriptions dispensed at a military pharmacy. Data indicate that the frequency of naloxone coprescription to patients at risk for opioid overdose was significantly higher when the naloxone tool was used than when the tool was not used.
描述一种药房临床决策支持工具的开发、实施和评估情况，该工具旨在提高大型医疗系统中阿片类药物过量风险人群的纳洛酮联合处方率。
军事卫生系统阿片类药物登记处及基础展示层被用于开发一种临床决策支持功能，以改善药房护理点的纳洛酮联合处方情况。药房工作人员使用患者识别卡条形码扫描仪或手动输入患者识别号，以便快速查看患者阿片类药物过量风险及与疼痛相关的病史信息，并在适当情况下获得联合开具纳洛酮的建议。该工具可供军事治疗机构药房使用。还开发了一个交互式仪表板，以支持对阿片类药物过量风险患者的纳洛酮联合处方进行监测、利用情况分析及影响评估。
由于终端用户缺乏认识，纳洛酮工具的初步实施进展缓慢。由于一些全企业范围的教育举措，提高工具使用率的努力在一定程度上取得了成功。2020年初，军事药房发放的所有阿片类药物处方中有15%使用了纳洛酮工具。数据表明，使用纳洛酮工具时，开具给阿片类药物过量风险患者的纳洛酮联合处方频率显著高于未使用该工具时。
