Abstract
Background Not all patients at risk for opioid overdose are prescribed naloxone when discharged
from the emergency department or hospital. Clinical decision support (CDS) can be
used to promote clinical best practices, such as naloxone prescribing; however, it
may be ignored due to knowledge deficiencies or alert fatigue.
Objectives Assess the effect of academic detailing on responses to a CDS alert recommending
a naloxone prescription for patients at risk of opioid overdose.
Methods A pre/postquality improvement study of 2,161 active providers at a 400-bed academic
medical center. The first intervention was an educational email to all providers.
The second intervention was individual emails to 150 providers who infrequently ordered
naloxone in response to the alert. The main outcome measure was prescription-to-alert
ratios, defined as the number of naloxone prescriptions signed in response to the
alert divided by the number of times the alert fired.
Results The first academic detailing intervention resulted in a prescription-to-alert ratio
increase from 32.6 to 51.7%, a 19.1% absolute increase when comparing the approximately
8 months before and after the email was sent (95% confidence interval [CI]: 16.3–21.9%,
p < 0.001). The second intervention resulted in an increased prescription-to-alert
ratio from 9.3 to 50.6%, an absolute increase of 41.3% when comparing the nearly 8
months before and after the emails were sent (95% CI: 36.9–45.7%, p < 0.001). Improvements were seen across all services and all provider roles, particularly
for advanced practice providers, and were sustained for 8 months.
Conclusion Academic detailing can be used to augment responses to CDS for patients with opioid
dependence. Further study is needed to see if this effect can be replicated with CDS
for other high priority conditions, and whether academic detailing with one alert
might improve responses to other alerts as well, potentially decreasing alert fatigue.
Keywords
formative feedback - clinical decision support systems - alert fatigue - opioid-related
disorders - naloxone
