Table 2:

Implementation Strategy

Corporate / Administrative Support
CBHS Pharmacy	Chain Pharmacy
Setting naloxone as a pharmacy goal and performance metric Allocating funding for uninsured patients “We’ve always thought that Naloxone is very important. We’ve always put priority on that. We do think that there’s a lot of substantial evidence base for it. And so, it’s always been a priority for us in terms of reducing harms for the people that we see here, so that was also a component as well.”	Computer system provide morphine milliequivalent calculator and flags patients for naloxone recommendation Automatically applies manufacturers coupon for out of pocket cost “But I would say recently the company pushed a protocol to have itfor allpatients flagged between the 50 and 90 or even more morphine equivalents. So we kind of had a huge burst ofprescribing it, but it’s kind of died down for now as we’ve already had most of our patients, yeah, on it.”
Pharmacist Led Efforts
Having a champion to spearhead implementation Creating pre-fill screening and prescription forms Consolidating naloxone resources and documents in an organized binder “I think having like a champion, somebody that was willing to pilot it and write everything up and then spend time with staff to make sure they were comfortable doing it was helpfulfor us. I kind of think having a point person, if you’re just starting something, is helpful.”	Pharmacists being proactive in identifying and recommending naloxone Organize paperwork to streamline furnishing and documentation Using CDC application to calculate MME “It’s kind of on the store to reach out, get those resources and establish it and find a time put it in the workflow” “We organize all the paperwork. So you’re just picking one paper from each required component and then we batch it into their bag.”
Increasing Pharmacist Engagement
Directing pharmacists towards free naloxone training Team effort for pharmacy staff in training each other and furnishing naloxone “…discussing it with your team too. It’s nice for us, we made it a team approach, the technicians, everybody, we got them involved. Like, you guys should have this, we’re going to have this, we’re going to practice furnishing on each other, and then we’re all going to practice furnishing or recommending it to our clients.”	Corporate providing free naloxone CE training Informing providers and hospitals of pharmacist’s ability to furnish naloxone “…so sometimes if we’re on the phone with the prescriber [to] clarify something about an opioid. While we’re on the phone, we’lljust say, “Hey, we noticed this patient’s not on naloxone. Can wejust prescribe it in your behalf?” A lot of times [they’re] like, Oh yeah, that’s a great idea. So sometimes that makes things even easier and faster, [having] a conversation about that.”
Increasing Patient Engagement
Advertise through radio, poster in waiting room, community outreach events, and city’s resource listing Recommend naloxone to all patients Offer different formulations of naloxone and chosen based on patient preference Provide a safe and respectful environment for patients “We recommend Naloxone to just about everybody. So we have signs in the waiting room that are related to if you use any… If you get any drugs, medications that are not from a pharmay that are illicit, we recommend you have Naloxone. We have had overdoses in the city from all sorts of things contaminated with fentanyl or opiates.”	Prepare naloxone and have it ready before recommending naloxone to patient Ensure patients understand the importance and benefits of naloxone “When [the naloxone is] already all finished and done and it’s right in front of them and you’re counseling them, it’s better than trying to get their consent and then putting it in the works and having them come back later. Maybe even forgetting about it. So yeah, just fast, people just want to get in and out quick, quick service.” “I like to use the seatbelt andfire extinguisher analogy. So for example, it’s like having a seatbelt, you never expect to get in a crash, but it can save your life when it’s there and there can be others circumstances not underyour control”