Safer Opioid Prescribing Protocol (SOPP) is a best practice alert (BPA) digital procedural intervention for prescription opioid overdose prevention, patient opioid education, and promotion of naloxone coprescription.
The SOPP intervention integrates into a pre-existing electronic health record (EHR), through which it sends electronic best practice alerts (BPAs) to prescribers and nurses to promote safe opioid prescription practices. To inform and reduce high-dose opioid prescription, SOPP assigns the EHR of each patient an opioid risk factor score (based on comorbidities, coprescription risks, dose level, illicit drug use, previous substance use treatment, and previous opioid overdose events in the past 12 months). When a patient receives a prescription for opioid medication, a SOPP BPA alerts the prescriber and shows a precalculated table of the maximum morphine milligram equivalent (MME) value of opioid safe for that patient at discharge. SOPP then asks the prescriber to indicate whether the prescribed discharge dose is ≥ 100 MME. If the discharge dose is ≥ 100 MME or the patient has a high opioid risk factor score, SOPP advises the prescriber to coprescribe naloxone. If the prescriber declines to coprescribe the patient naloxone, SOPP requires the prescriber to supply justification. Nurses receive up to 2 BPAs at discharge: BPA 1 reminds the nurse to teach the patient about safe opioid medication use. If the patient receives a naloxone coprescription, BPA 2 prompts the nurse to print a prepared patient education brochure on overdose identification/naloxone administration and instruct the patient (and family members) with a preassembled naloxone demonstration kit. SOPP also includes patient brochures with standardized instructions on safe use, storage, and disposal of opioid medications. All SOPP educational materials are available in English, Spanish, and Portuguese.
Brief Intervention (BI)
Best Practice Alerts (BPA)
Evaluation of a Safer Opioid Prescribing Protocol (SOPP) for patients being discharged from a trauma service
Baird J, Faul M, Green T, et al. Journal of Trauma Nursing. 2019. (26)3: 113-120. doi: 10.1097/JTN.0000000000000435
Summary: Researchers analyzed patient health outcomes in the EHRs of adult trauma patients (n = 509) in a prospective observational study of the effects of Safer Opioid Prescribing Protocol (SOPP) implementation on prescription of opioid medication, patient opioid safety education, and naloxone coprescription at an urban Level 1 trauma center in New England that serves over 2,900 adult patients per year. Researchers collected EHR data from 3 patient cohorts (cohort 1: pre-SOPP implementation (n = 191), cohort 2: early SOPP implementation (n = 168), cohort 3: maintenance-phase SOPP implementation (n = 150) across 3 non-sequential 3-month periods between July 1, 2014 to May 31, 2016. All patients were at least 18 years old and had received a prescription for opioid analgesic medication at discharge. Results extracted from patient EHRs revealed significant reductions in patients discharged with opioid prescriptions – 10% reduction from cohort 1 (94% of patients) to cohort 3 (84% of patients). Median number of pills per patient prescription decreased over 33% from cohort 1 (60 pills) to cohort 3 (40 pills). While SOPP did not affect the median prescribed opioid dose (90 MME), there was a significant decrease in high-dose opioid prescription (≥100 MME) under SOPP. Researchers observed significant increases in prescription of nonnarcotic medication (18% increase from cohort 1 (75% of patients) to cohort 3 (93% of patients), naloxone prescription for patients with a SOPP-identified opioid risk factor (9% increase from cohort 2 (91% of patients) to cohort 3 (100% of patients), and provision of opioid safety education (3.5% increase from cohort 2 (34.5% of patients) to cohort 3 (38.0% of patients).
Take Away: Implementation of SOPP at an urban New England Level 1 trauma center fostered significant increases in patient opioid safety education, prescription of nonnarcotic pain medication, and coprescription of naloxone, and a substantial reduction in high-dose opioid prescriptions (≥100 MME) in adult trauma patients.