Presenter Status
Resident/Psychology Intern
Abstract Type
QI Project
Primary Mentor or Principal Investigator
Michelle DePhillips
Presentation Type
Oral Presentation
Start Date
11-5-2026 12:30 PM
End Date
11-5-2026 12:45 PM
Abstract Text
Problem Statement/Question: Opioid overdose is one of the leading causes of death in the pediatric population, primarily in adolescents. The 2024 American Academy of Pediatrics (AAP) opioid prescribing guidelines recommend that naloxone be co-prescribed with opioids as prevention for future overdose deaths. However, in 2024, naloxone was co-prescribed with only 1% of opioids written from our emergency departments (ED).
Background/Project Intent (Aim Statement): This quality improvement initiative aims to increase the percentage of naloxone co-prescribed with opioids at a pediatric tertiary care ED and pediatric community ED from 1% to 50% by March 2026.
Methods (include PDSA cycles): Root cause analysis identified two major barriers: lack of knowledge of new guidelines as well as provider burden with prescribing and educating families on a second medication. A PICK chart and key driver diagram guided countermeasure development implemented in plan-do-study-act (PDSA) methodology. The outcome measure was the percentage of opioid prescriptions with co-prescription for naloxone. The process measure was the percentage of naloxone prescriptions with discharge education provided, and the balancing measure was total opioid prescriptions. In the first PDSA (June 2025), an additional sentence was added in a preexisting pop-up for opioid prescriptions in the electronic medical record (EMR) reminding providers to co-prescribe naloxone. The second PDSA (August 2025) included in person education to ED physicians and pediatric residents.
Results: There was an average of 96 opioid encounters per month from January 2024 – December 2025; 99 encounters per month during baseline data collection and 88 encounters per month after interventions. The percentage of naloxone co-prescription increased twice, from 1% to 4.7% with release of the AAP guideline (November 2024) and again to 26% with EMR notification and provider education (August 2025). The percentage of naloxone discharge education provided, and the number of opioid prescriptions did not change.
Conclusions: Though our goal has not been reached after the first two PDSA cycles, improvement has been made. The most impactful intervention was education for our prescribers on the new AAP guideline. The greatest barrier for high-reliability interventions centered around the hospital's transition to a different EMR system precluding us from implementing automatic co-prescription of naloxone with opioids. We believe this would be the most effective intervention and plan to implement this when the new EMR goes live in early 2026.
Increasing Concomitant Naloxone and Opioid Prescribing from a Pediatric Emergency Department: QI Project
Problem Statement/Question: Opioid overdose is one of the leading causes of death in the pediatric population, primarily in adolescents. The 2024 American Academy of Pediatrics (AAP) opioid prescribing guidelines recommend that naloxone be co-prescribed with opioids as prevention for future overdose deaths. However, in 2024, naloxone was co-prescribed with only 1% of opioids written from our emergency departments (ED).
Background/Project Intent (Aim Statement): This quality improvement initiative aims to increase the percentage of naloxone co-prescribed with opioids at a pediatric tertiary care ED and pediatric community ED from 1% to 50% by March 2026.
Methods (include PDSA cycles): Root cause analysis identified two major barriers: lack of knowledge of new guidelines as well as provider burden with prescribing and educating families on a second medication. A PICK chart and key driver diagram guided countermeasure development implemented in plan-do-study-act (PDSA) methodology. The outcome measure was the percentage of opioid prescriptions with co-prescription for naloxone. The process measure was the percentage of naloxone prescriptions with discharge education provided, and the balancing measure was total opioid prescriptions. In the first PDSA (June 2025), an additional sentence was added in a preexisting pop-up for opioid prescriptions in the electronic medical record (EMR) reminding providers to co-prescribe naloxone. The second PDSA (August 2025) included in person education to ED physicians and pediatric residents.
Results: There was an average of 96 opioid encounters per month from January 2024 – December 2025; 99 encounters per month during baseline data collection and 88 encounters per month after interventions. The percentage of naloxone co-prescription increased twice, from 1% to 4.7% with release of the AAP guideline (November 2024) and again to 26% with EMR notification and provider education (August 2025). The percentage of naloxone discharge education provided, and the number of opioid prescriptions did not change.
Conclusions: Though our goal has not been reached after the first two PDSA cycles, improvement has been made. The most impactful intervention was education for our prescribers on the new AAP guideline. The greatest barrier for high-reliability interventions centered around the hospital's transition to a different EMR system precluding us from implementing automatic co-prescription of naloxone with opioids. We believe this would be the most effective intervention and plan to implement this when the new EMR goes live in early 2026.
