A Pilot Study to Increase Naloxone Education and Prescriptions in Sickle Cell Clinics
Authors: Merriweather Brenda , Speller-Brown Barbara J , Campbell Andrew D 
Published: June 2024

Abstract

Presentation Date: 6/9/2024
Presentation Start Time: 3:15:00 PM

Background
Sickle Cell Disease (SCD) is a chronic, painful, and debilitating disease. Patients with SCD are routinely prescribed opioids for the treatment of pain crisis episodes. It is strongly recommended that opioids be prescribed with naloxone according to the American Society of Hematology 2020 guidelines for SCD. Naloxone (Narcan) is an opioid antagonist medication used to reverse an opioid overdose death. Not all SCD providers consistently co-prescribe opioids with naloxone. In addition, patients and their families are not always educated on the indications for naloxone or how to administer it. The majority of patients with SCD in the United States are African-American and are less likely to be prescribed naloxone compared to White patients. This pilot study aimed to determine if a quality improvement initiative can increase deliberate instruction on naloxone use and administration for pediatric patients and families and increase the number of naloxone prescriptions in pediatric SCD clinics at Children’s National Hospital.

Methods
Three different SCD provider clinics were chosen to examine this pilot study. The inclusion criteria were that the patient has an SCD diagnosis, be prescribed at least one opioid, and be present for that clinic day to participate in an education session. The pre-intervention phase was from June 5, 2023, through June 20, 2023. The post-intervention phase was from June 21, 2023, through July 7, 2023. A detailed checklist and naloxone fact sheets were sent to each provider before the intervention phase. Email reminders were sent to each provider once weekly to remind them to prescribe naloxone and perform an education session. Nurse coordinators for each provider were asked to type a reminder cue at the top of the provider’s clinic preparatory list to prescribe naloxone for each patient. Medical records were reviewed for patients during the pre-intervention and post-intervention phases to determine the presence of a naloxone prescription and documentation in the clinic note of a naloxone education session.

Results
In the pre-intervention phase, Provider A prescribed Narcan for 11.1 % of patients, and performed an education session with 11.1% of patients. In the post-intervention phase, Provider A prescribed Narcan for 22.7 % of patients and performed an education session with 22.7% of patients. In the pre-intervention phase, Provider B prescribed Narcan for 0% of patients and performed an education session with 0% of patients. In the post-intervention phase, Provider B prescribed Narcan for 37% of patients and performed an education session with 37% of patients. In the pre-intervention and the post-intervention phase, Provider C did not have any eligible patients for this pilot study.

Conclusions
The results demonstrated that a combination of a detailed checklist, Narcan fact sheet, reminder emails, and reminder cues can increase the number of Narcan prescriptions, increase education sessions on Narcan, and increase the documentation of education sessions.

Clinical Implications
A pilot study such as this one can be duplicated to perform a larger-scale study. The study was cost-effective, including the fact that providers can order a free Narcan training kit to teach Narcan nasal spray administration. The study was performed at no cost to the department. This study can be duplicated in other Children’s National Hospital departments where Narcan prescriptions are written. More patients can be protected from fatal overdose with the implementation of this safety initiative. Every effort should be made to ensure naloxone is covered by insurance, patients have access to it, and understand how to administer it.