A standardized team-based approach for identifying naloxone-eligible patients in a grocery store pharmacy.

Objectives: To define a standardized team-based approach to identify naloxone-eligible patients in a community pharmacy and to evaluate the impact of the approach on the number of naloxone orders dispensed.

Setting: Two locations within one district of a chain pharmacy.

Practice Description: Kroger is a national grocery store pharmacy.

Practice Innovation: A standardized team-based approach was implemented from November 2017 to February 2018 into the dispensing workflow to identify naloxone-eligible patients. Training was provided to team members (e.g., pharmacist, student pharmacist, technician) at the intervention store. Persons age 18 years and older who met more than 1 of the following criteria were included: greater than or equal to 50 morphine milligram equivalents per day, concurrent benzodiazepine and opioid use, fentanyl patch greater than or equal to 25 μg/h, and documented or verbal history of overdose or substance use disorder. Persons were excluded if they were younger than 18 years, did not speak English, or received an opioid prescription of less than 5 days' duration and no opioid exposure during the previous 30 days.

Evaluation: If inclusion criteria were met, a clinical flag was placed in the dispensing system, alerting the pharmacist to speak with the patient at pick-up. The pharmacist educated the patient on the risks of opioid medications and the benefits of naloxone and then offered to dispense naloxone. The control store followed standard of practice. Data were evaluated using descriptive statistics.

Results: The intervention and control store each dispensed 3 naloxone orders from November 2016 to February 2017. During the study period, 39 persons were identified as eligible for naloxone, and 11 naloxone orders were dispensed at the intervention store (28.2%); 2 naloxone orders were dispensed at the control store. A standardized team-based approach resulted in dispensing 8 additional naloxone orders at the intervention store, representing a 367% increase compared with the prior year, when this approach was not used.

Conclusion: A standardized team-based approach was successfully implemented in a grocery store pharmacy and resulted in increased naloxone dispensing to naloxone-eligible patients.