EHR-Based Decision Support Improves Naloxone Co-Prescribing
An EHR-based clinical decision support (CDS) intervention was shown to successfully improve naloxone co-prescribing rates for patients at discharge. The study demonstrates the real-world impact that well-designed, workflow-integrated CDS tools can have on patient safety and public health outcomes.
- One study of an interruptive EHR-based alert for high-risk opioid prescriptions found it increased naloxone co-prescribing by 4.7 prescriptions per 100 opioid prescriptions per week. The clinical decision support (CDS) alert was triggered in 6.36% of all discharge opioid prescriptions within the integrated health system studied. - Transitioning from an ICU role to nursing informatics often requires a Bachelor of Science in Nursing (BSN), with many employers preferring a Master's in Nursing Informatics or a related certification like the ANCC Informatics Nurse Certification (RN-BC). Key skills for this career path include a strong clinical background, technical aptitude, project management, and analytical skills. - Frustration with EHR usability is a significant factor in nurse burnout, with common complaints including slow system response times, inefficient workflows that hinder patient care, and a lack of sufficient training. Informatics nurses play a crucial role by working with IT teams and vendors to optimize these systems, ensuring they support clinical workflows effectively. - Interoperability standards like HL7 FHIR (Fast Healthcare Interoperability Resources) are critical for the seamless exchange of healthcare data between different systems. FHIR utilizes modern web standards like RESTful APIs, which allows for the development of applications that can plug into various EHRs for functions like clinical decision support. - Federal regulations from the ONC and CMS, stemming from the 21st Century Cures Act, mandate the use of standardized APIs to promote interoperability and patient access to their health information. This requires healthcare providers and IT vendors to adopt technologies like FHIR to ensure compliance. - A key framework for designing effective CDS interventions within an EHR like Epic is the "Five Rights": providing the right information to the right people in the right formats through the right channels at the right points in the workflow. This approach helps to prevent alert fatigue and ensures that advisories are relevant and actionable for clinicians. - While state laws mandating naloxone co-prescribing have been implemented in at least 10 states, their effect on overall opioid overdose mortality rates is mixed. One study found these mandates significantly reduced prescription opioid-related deaths by 16% but had no significant impact on deaths from illicit or synthetic opioids. - Nursing informatics specialists are integral to the entire lifecycle of health IT systems, with their most common duties being system implementation, optimization, and project management. They act as a bridge between clinical end-users and technical teams, ensuring that the technology meets the needs of patient care.
