889 - A Qualitative Root-Cause Analysis of the Underprescription of Naloxone upon Discharge from an Inpatient Rehabilitation Facility

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

RE

Rachel Esparza, MD

Resident Physician
Northwestern University/Shirley Ryan AbilityLab
Chicago, Illinois, United States

Co-Author(s)

JM

Jessica V. Marone, MD

Resident Physician
Northwestern/Shirley Ryan AbilityLab
Chicago, Illinois, United States
SS

Shane N. Stone, MD

Spinal Cord Injury Medicine Fellow
Rutgers Health/New Jersey Medical School
Newark, New Jersey, United States
PM

Priya V. Mhatre, MD, MS

Attending Physician
Shirley Ryan AbilityLab
Chicago, Illinois, United States

Objectives: The objective of this quality improvement study was to explore factors contributing to the underprescription of naloxone for patients at high risk of opioid overdose upon discharge from inpatient rehabilitation.

Design: Semi-structured interviews were conducted with 8 inpatient attending physicians at a single-center inpatient rehabilitation facility. Participants were identified based on the providers who had the highest number of at-risk patients, as determined by the 2022 Center for Disease Control guidelines, who had not received a prescription (or recommendation) for naloxone upon discharge. Interviews were transcribed and coded by two independent researchers using an inductive approach to assess for key themes.

Results: Several themes emerged from the data suggestive of possible root-causes. These themes included: (1) the notion that the patient population was not at risk for adverse effects of opioids including overdose, (2) concern for potential harm including stigma, cost, and compliance, (3) concern for prescribing without adequate naloxone training infrastructure, (4) provider comfort and familiarity with prescription, and (5) belief that prescribing naloxone falls outside the scope of an inpatient rehabilitation physician’s practice. Of note, while the majority (6, 62.5%) of participants were familiar with the 2022 Center for Disease Control guidelines for assessing patient risk of opioid overdose, (4, 50%) reported familiarity with recommendations for naloxone prescribing.

Conclusions: Taken together, this analysis demonstrates barriers and opportunities to address naloxone underprescription within inpatient rehabilitation. Quality improvement interventions focused on addressing knowledge gaps and misconception regarding naloxone prescription and patient risk assessment as well as implementation of supportive hospital infrastructure may help to support appropriate naloxone prescription for patients at risk of opioid overdose.