ORIGINAL RESEARCH Implementing an Opioid Risk Reduction Program in the Acute Comprehensive Inpatient Rehabilitation Setting Stephanie P. Van, MD, a Ada Lyn Yao, MD, a Teresa Tang, MD, a Margaret Kott, MD, a Amira Noles, MD, a Nicholas Dabai, DO, a Alexis Coslick, DO, a Solomon Rojhani, MD, a Lee Ann Sprankle, MSN, RN, CPHQ, c Erik H. Hoyer, MD a,b From the a Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD; b Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD; and c Department of Quality Improvement, Johns Hopkins Hospital, Baltimore, MD. Abstract Objective: To describe the implementation and evaluation of an interdisciplinary quality improvement (QI) project to increase prescription of take-home naloxone (THN) to reduce risks associated with opioids for patients admitted to an acute inpatient rehabilitation unit. Design: Prospective cohort quality improvement project. Setting: Eighteen-bed acute comprehensive inpatient rehabilitation (ACIR) unit at a large academic institution. Participants: Patients admitted to ACIR between December 2015-November 2016 (NZ788). Interventions: An interdisciplinary QI model comprised of planning, education, implementation, and maintenance was used to implement a THN and opioid risk-reduction program involving provider and patient education. Analyses consisted of comparisons between baseline, early, and late phases of the project. Main Outcome Measures: (1) The proportion of eligible patients who received a prescription for naloxone upon discharge from ACIR; (2) the proportion of patients originally admitted to ACIR on opioids that were weaned off upon discharge. Results: The adjusted odds of eligible patients being discharged from ACIR with a naloxone prescription during the late QI period were 7 (95% confidence interval [CI]: 3-21) times higher than during the early QI period (late QI period: 43%, 95% CI: 25%-63%; early QI period: 10%, 95% CI: 3%-28%; P< .001). For patients admitted on opioids, the adjusted odds of being weaned off opioids during the late QI period were 10 (95% CI: 4-25) times higher than during baseline (late QI period: 29%, 95% CI: 17%-45%; baseline: 4%, 95% CI: 1%-10%; P< .001). Conclusions: Implementation of a THN and opioid risk reduction QI project in an inpatient rehabilitation setting led to significantly more eligible patients receiving naloxone and more patients weaned off schedule II opioids. Archives of Physical Medicine and Rehabilitation 2019;100:1391-9 ª 2019 by the American Congress of Rehabilitation Medicine Opioids are highly effective analgesic medications, but they have great potential for abuse, dependence, and lethal overdose, which contributes to increased morbidity and health care costs. Since the late 1990s, the United States has experienced a nationwide opioid epidemic driven by a significant rise in opioid over prescription. In 2015, prescription and illicit opioids were responsible for more than 33,000 overdose deaths in the United States. 1 Opioid-related adverse drug events (ADEs) also pose a significant burden on the health care and social systems, as the total costs of opioid-related health care, addiction treatment, lost productivity, and criminal justice involve- ment are estimated at $78.5 billion per year. 2 Contributing factors to opioid-related ADEs include wide availability, improper storage and disposal, and lack of education and counseling. 3 In the acute comprehensive inpatient rehabilitation (ACIR) setting, patients are frequently admitted after a variety of medical and surgical interventions and complications that require optimal pain management to help them achieve their rehabilitation goals. Poorly controlled pain during rehabilitation can limit motivation and participation in therapy, resulting in extended length of stay Disclosures: none. 0003-9993/19/$36 - see front matter ª 2019 by the American Congress of Rehabilitation Medicine https://doi.org/10.1016/j.apmr.2019.04.011 Archives of Physical Medicine and Rehabilitation journal homepage: www.archives-pmr.org Archives of Physical Medicine and Rehabilitation 2019;100:1391-9