Impact of a pharmacist-driven intervention on the outpatient dispensing of naloxone

Abstract

Objectives: To determine whether implementation of a pharmacist-driven intervention increased naloxone prescriptions dispensed in outpatient pharmacies within an academic medical center.

Setting: Five outpatient pharmacies affiliated with the Wake Forest Baptist Health System located in Forsyth, Davie, and Davidson counties in North Carolina.

Practice description: Every pharmacy site differs in physical location, customer base, and other provided services. These differences, along with large ranges of prescription volumes and levels of care, provided varying opportunities for naloxone dispensing.

Practice innovation: Patients at high risk for opioid overdose and who were identified for the pharmacist-driven intervention were provided overdose education and an offer to receive naloxone per North Carolina State Health Director's Standing Order. This quasi-experimental study included a pre-intervention period (3 months), staff education (1 month), and a post-intervention period (3 months). The intervention was the patient-specific education regarding respiratory depression or overdose risk factors and the offering of a prescription for naloxone. The primary endpoint was reported as the change in naloxone prescriptions dispensed.

Evaluation: The many factors why patients did and did not receive naloxone were discussed including patient understanding, convenience, and other pharmacy factors including workflow changes. Surprisingly, cost did not seem to play a factor in patient's inability to obtain the medication.

Results: Thirty-eight patients were eligible for the intervention. Two prescriptions for naloxone were dispensed during the preimplementation period, and 11 prescriptions for naloxone were dispensed during the postimplementation period (n = 0.0078).

Conclusions: The number of naloxone prescriptions dispensed increased after implementation of a pharmacist-driven intervention. All naloxone prescriptions were filled for patients eligible for study criteria; however, the North Carolina Standing Order allows any patient requesting to receive a naloxone prescription and thus all filled prescriptions were included in the count. Because of pharmacy staff education and overflow from the project into other areas, it is possible that the prescriptions filled for ineligible patients were still due to project efforts.