Abstract
Title: PRN Naloxone Prescription for Patients on Opioids in Gerontology Wards at Orpington Hospital — Quality Improvement Project
Team: EN Udoh; F Khan; N Vakilzadehian
Introduction:
Nearly half of elderly inpatients receive opioids for pain management. Due to co-morbidities and polypharmacy, these patients are at increased risk of opioid toxicity. Naloxone is the established antidote and should be prescribed alongside opioids to manage potential toxicity.
Aim:
To evaluate adherence to Trust guidelines for Naloxone prescription in gerontology wards.
Method:
Two spot audits were conducted between June and August 2025 across three geriatric wards, reviewing 57 patients. Following the first audit, interventions included:
• Teaching sessions for junior doctors and prescribers on audit findings.
• Nurse education on opioid toxicity signs and benefits of Naloxone.
• Posters placed at strategic locations.
• Collaboration with the Trust ICT team to integrate Naloxone prompts in the EPIC prescribing system (ongoing).
A second audit was conducted in August 2025 with findings shared in weekly geriatric teaching sessions.
Results:
In the first cycle, 42 patients were eligible; Naloxone was prescribed for 15 (35.7%). In the second cycle, 26 patients were eligible; 24 (92.3%) were prescribed Naloxone. Education efforts addressed staff knowledge gaps regarding opioid toxicity and escalation protocols. Integration with EPIC continues to support co-prescription.
Conclusion:
This project significantly improved Naloxone prescribing and guideline compliance, enhancing safety in a high-risk elderly population. Encouraging junior doctors to follow Trust policies is crucial. Though local, we feel this approach and its outcomes can be replicated across other Trusts.
Comments
This touches on a really…
This touches on a really important and often overlooked area. The trust I work in uses paper prescribing, but I think being able to add prompts to the electronic system when prescribing opioids is a really great idea. Your multi-pronged approach at educating doctors + nurses has had a really positive effect on patient safety, at 92% compliance! I imagine once co-prescription launches you will be able to raise that number even further, but its great to see such a big increase in compliance with the initial interventions.
Valuable Feedback
Thank you Isabel, yes 100% absolutely achievable when the EPIC co-prescription is launched.
Opioid toxicity
I think this is a really relevant subject which isn't talked about enough in our care of older adults, really like your multi-pronged approach involving both doctors and nurses
Thank you @ Dr Zheng
If your trust uses EPIC , you could replicate this QIP. Opioid toxicity in the Elderly is not uncommon and time is crucial in management.
Important topic
Really important and often overlooked topic, and I imagine doctors felt much more confident in managing opioid toxicity. Our hospital uses a standardised "care bundle" when patients are admitted and prescribed opioid medication, to ensure PRN naloxone is co-prescribed with opioids. During the project, did you find that the pre-emptive PRN naloxone prescriptions improved treatment rates for opioid toxicity?
Aim Achieved
Absolutely Mr Honey, in my trust, if a medication is not on a patients chart', it takes quite some time after prescription for Pharmacy to dispense said medication, its easy if its a common and uncontrolled medication that is available on the ward and many patients use. Imagine, if there's an opioid toxicity. For Naloxone, we preordered/prescribed as soon as patient was admitted, that way it was dispensed before the patient needed it. So it definitely improved treatment rates/outcomes .