Naloxone Coprescribing Across a Pediatric Health System: A Quality Improvement Initiative.

Abstract

To increase naloxone coprescribing to ≥80% among patients prescribed opioids as outpatients by December 31, 2024 regardless of gender, race, or preferred language. We conducted a quality improvement initiative at the Children's Hospital of Philadelphia from October 2023 to June 2025. In 3 phases, we implemented an electronic health record-based automated alert to coprescribe naloxone, combined with education for providers, nurses, patients/families, and pharmacists. The primary outcome was the proportion of patients with an outpatient opioid prescription who were coprescribed naloxone ("coverage"). We also tracked naloxone dispensing from Children's Hospital of Philadelphia pharmacies (outcome measure) and provider engagement with the alert (process measure). Balancing measures included provider-reported ease of prescribing naloxone and comfort offering naloxone. Compared with a 1-year baseline period, average monthly naloxone coverage increased from 3.0% to 84.1% enterprise-wide. Although early feedback revealed that perceived stigma and naloxone cost were barriers to dispensing, the proportion of orders for naloxone dispensed at our internal pharmacy during the initiative was 59.1%. Most providers reported that naloxone was easy to prescribe (81.8%, 36/44) and reported high levels of comfort with offering naloxone to families (86.4%, 38/44). Electronic health record-based prompts, combined with education for providers, nurses, patients/families, and pharmacists, increased naloxone coprescribing across a diverse population of patients in a large pediatric health system.