Evaluation of Opioid Reversal with Naloxone before and after Implementation of a Computerized Physician Order Entry System at a Tertiary Medical Center

Objectives: Opioid medications consistently rank among the drugs most frequently associated with adverse events. We reviewed cases of naloxone administration to assess our opioid prescribing and administration practices before and after implementation of a computerized provider order entry (CPOE) system. Our primary measure was the rate of opioid reversal with naloxone in the two time periods. Methods: We systematically reviewed all cases of naloxone administration at our institution from March 2016 through May 2016 (before period) compared with cases from October 2017 through December 2017 (after period). Results: In the before period, 0.58% of patients who received an opioid required reversal with naloxone compared with 0.16% in the after period (p < 0.001). Subject demographics such as age, sex, BMI, and serum creatinine were not significantly different between the two groups. Similarly large proportions of patients in the before and after groups had at least 2 risk factors for over-sedation (79.5% and 75%, respectively, p = 0.17). More than 84% and 61% of patients in the before and after groups, respectively, did not have documentation of an opioid on the admission medication history, suggesting they were opioid-naïve (p = 0.10). Per our institution's policy on range orders, nurses should begin with the lowest prescribed opioid dose; this policy was followed in 58.3% in the before period and 69.2% in the after period (p = 0.36). Conclusions: Doses of naloxone that were required for opioid reversal were significantly reduced after implementation of a CPOE system. Our opioid-reversal rate was comparable to similar studies; however, secondary endpoints indicate that opioid prescribing and administration habits may not account for patient-specific risk factors for over-sedation.