Do electronic health record prompts increase take-home naloxone administration for emergency department patients after an opioid overdose?
Do electronic health record prompts increase take-home naloxone administration for emergency department patients after an opioid overdose?
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DOI：
10.1111/add.14635
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发表时间：
2019-09-01
期刊：
影响因子：
6
通讯作者：
Suffoletto, Brian
中科院分区：
文献类型：
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作者：
Marino, Ryan;Landau, Aaron;Suffoletto, Brian
背景和目的向阿片类药物过量（OD）存活的急诊科（ED）患者分发带回家的纳洛酮（THN）可以降低未来阿片类药物死亡率，但并不常见。我们研究了在OD患者出院时向急诊科医生提供的电子健康记录（EHR）提示是否可以改善THN分布。设计中断时间序列分析，以比较2017年6月18日实施电子病历提示前后11个月内接受THN治疗的过量用药患者百分比。2016年7月至2018年4月，在宾夕法尼亚州西部的一个卫生系统中，共有3492名被诊断为吸毒过量的成年患者从9个急诊科出院。干预和比较：电子病历提示是由护士最初评估笔记中出现的特定术语触发的。在急诊科医生出院过程中，电子病历显示一个弹出窗口，要求医生考虑给病人开处方或提供纳洛酮。比较者为“无电子病历提示”。测量方法基于ICD诊断代码和主诉关键词的标准标准。2016年7月，16.3%[95%可信区间(CI) = 14.0, 18.5]的OD患者接受THN治疗，截至2017年6月，每月下降1.2% （P < 0.0001, 95% CI = 0.8,1.7）。在电子病历提示后的每个月，接受THN治疗的OD患者增加2.8% （P < 0.001, 95% CI = 2.0, 3.5）。ehr前提示THN分布最高的ED未出现增加。在实施电子病历提示之前，THN的分布率因患者年龄和种族而异，而在实施电子病历提示之后则没有。结论电子健康记录提示与阿片类药物过量出院的急诊科患者纳洛酮带回家分配增加有关。
Background and Aims Distribution of take-home naloxone (THN) to emergency department (ED) patients who have survived an opioid overdose (OD) could reduce future opioid mortality, but is not commonly performed. We examined whether electronic health record (EHR) prompts provided to ED physicians when discharging a patient after an OD could improve THN distribution. Design Interrupted time-series analysis to compare the percentage of OD patients who received THN during the 11 months before and after implementation of an EHR prompt on 18 June 2017. Setting and participants A total of 3492 adult patients with diagnoses of OD discharged from nine EDs in a single health system in Western Pennsylvania from July 2016 to April 2018. Intervention and comparator The EHR prompt was triggered by the presence of specific terms in the nurse's initial assessment note. The EHR displayed a pop-up window during the ED physician discharge process asking the physician to consider prescribing or providing naloxone to the patient. The comparator was 'no EHR prompt'. Measurements Measurements were based on standard criteria from ICD diagnostic codes and chief complaint keywords. Findings In July 2016, 16.3% [95% confidence interval (CI) = 14.0, 18.5] of OD patients received THN, which decreased every month through June 2017 by 1.2% (P < 0.0001, 95% CI = 0.8,1.7). For each month post-EHR prompt there was an increase of 2.8% of OD patients receiving THN (P < 0.001, 95% CI = 2.0, 3.5). No increases occurred in the ED with the highest pre-EHR prompt THN distribution. Rates of THN distribution varied by patient age and race prior to, but not after, implementation of EHR prompts. Conclusions Electronic health record prompts are associated with increased take-home naloxone distribution for emergency department patients discharged after opioid overdoses.