Abstract

Problem: The opioid epidemic continues to contribute to significant morbidity and mortality in the United States, with inconsistent naloxone access among high-risk patients discharged with opioid prescriptions. The purpose of this project was to implement and evaluate a naloxone co-prescribing process for high-risk adult patients discharged from the emergency department (ED) while enhancing staff knowledge and confidence in naloxone co-prescribing practices over a 30-day period.

Intervention: Guided by the Iowa Model of Evidence-Based Practice, this project implemented the Opioid Risk Tool (ORT) to identify ED patients at increased risk for opioid misuse and provided a structured educational program for ED staff. A pretest–posttest survey design was used to assess changes in ED staff knowledge and confidence before and after implementation of the intervention during the 30-day pilot period.

Measures: Outcome measures included changes in ED staff knowledge and confidence, frequency of ORT use, and rates of naloxone co-prescribing among patients identified as being at increased risk for opioid misuse.

Results: Ten ED staff members completed the pre-education survey, and one completed the post-education survey, precluding statistical analysis. Pre-intervention knowledge scores averaged 93%, and 40% of respondents strongly agreed they were confident in referring patients and families to community resources when providing naloxone education. One Opioid Risk Tool was completed during the pilot period. Naloxone co-prescribing at ED discharge increased by 50%, from four prescriptions in the 30 days before implementation to eight prescriptions during the pilot period. However, limited post- intervention survey participation and minimal use of the Opioid Risk Tool prevented evaluation of the intervention effectiveness through statistical analysis.

Conclusion: A standardized naloxone co-prescribing process supported by risk screening and staff education may enhance provider practice and support broader overdose prevention efforts in emergency department settings.

Author Details

Lead, submitting author:

Autumn K. Boyd, DNP(c), BSN, RN 6 years RN experience

Co-authors:

Gina Crudden DNP, APRN-CNS, ACCNS-AG, CMSRN, FCNS, CDP; Shelley Hultman DNP, APRN-CNS, AGCNS-BC, SANE-A, CEN

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Quality Improvement

Research Approach

Mixed/Multi Method Research

Keywords:

Opioid Overdose, Drug Overdose, Naloxone Co-Prescribing, Naloxone, Emergency Department, Hospital Emergency Services, Opioid Risk Tool, Risk Assessment, Opioid Misuse, Opioid Abuse, Overdose Prevention, Substance Abuse Prevention

Advisor

Gina Crudden

Degree

DNP

Degree Grantor

Nebraska Methodist College

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Self-submission

Date of Issue

2026-09-14

Full Text of Presentation

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