Improving Naloxone and Buprenorphine Provision in the Pediatric Emergency Department Through Education and Chief Complaint-Triggered Screening

OBJECTIVE: Opioid use disorder (OUD) among US adolescents represents a public health crisis, with overdose deaths becoming a leading cause of mortality. Despite their efficacy, naloxone and buprenorphine remain underutilized. The pediatric emergency department (PED) presents an intervention opportunity, as many adolescents with OUD present there before fatal overdoses. This quality improvement initiative examined the use of education and hybrid screening to improve the provision of naloxone and buprenorphine in the PED. METHODS: A multifaceted OUD screening and treatment protocol was implemented in a PED using Best Practice Alerts (BPA) triggered by specific chief complaints (CC), alerting providers to the need for additional screening. Components included provider education, formulary changes, and clinical pathways. Data from adolescent encounters over 45 months were analyzed, comparing naloxone and buprenorphine prescribing rates before and after implementation. Secondary analyses examined demographics, insurance, and psychiatric comorbidities. RESULTS: During the study, 63 adolescents initiated buprenorphine, and 246 received naloxone. Among patients with BPA-qualifying CCs, naloxone dispensing increased from 3.89% to 11.39% and buprenorphine prescribing increased from 1.04% to 2.46%. Postimplementation, Black/African American adolescents and those with government insurance received more medications than peers, and overall naloxone prescribing increased from 0.4% to 0.79% of all visits. Patients triggering the BPA experienced longer ED stays regardless of medication receipt, with no increase in return visits. CONCLUSIONS: Electronic screening alerts coupled with provider education increased the provision of medications for adolescents at risk for opioid-related harm. The intervention is achievable in a PED without increasing return visits.