Naloxone distribution in the emergency department: An evidence based harm reduction strategy
Stephanie C. Mullennix, MSN, RN, CEN, AGCNS-BC; Jackeline Iseler, DNP, RN, ACNS-BC; Nicholas Kuhl, MD, FACEP; Gregory M. Kwiatkowski, PharmD, BCPS; Eric VanDePol, MD; Cara Anne Poland, MD, Med; Jeffrey V. Skinner, MHA, BSN, RN, CEN
- Sigma Affiliation
Visits vs Downloads
Visitors - World Map
Top Visiting Countries
Top Visiting Cities
Visits (last 6 months)
Downloads (last 6 months)
Popular Works for Mullennix, Stephanie C. by View
Popular Works for Mullennix, Stephanie C. by Download
Session G presented Tuesday, October 1, 1:00-2:00 pm
Purpose: Opioid related mortality is a significant problem at the national and local level. Naloxone is an opioid antagonist that can reverse the life threatening respiratory depression associated with an opioid overdose. The purpose of this quality improvement project is to implement a Emergency Department (ED) naloxone distribution program for a large, integrated healthcare system.
Design: This evidence based quality improvement project is one component of a hospital systems comprehensive strategy to decrease harm incurred on the local community by the opioid epidemic.
Setting: The project was set at a multi-site, teaching health system in the Midwest. The initial pilot was implemented at the hospitals largest quaternary, adult ED in an urban setting whose annual census exceeded 112,000 in 2017.
Participants/Subjects: Through analysis of historical ED visit data, it was identified that 261 patients presented to the urban pilot site following and opioid overdose in 2017, and over 500 ED visits throughout the entire health system were attributed to an opioid overdose. The focus of the intervention includes adolescents through adults.
Methods: A literature search strategy was designed to identify best-practice methods for implementing a naloxone distribution program within the ED. The literature was appraised and an interdisciplinary team was formed to design the implementation strategy. Donabedian’s model was applied as the framework to drive achievement of the project outcome goals, organize the initial pilot and to direct the spread of the program to all EDs within the system. To identify patients at greatest risk of an opioid overdose electronic health records were analyzed to track the percentage of patients who were discharged from the ED following an opioid related overdose and received a take home naloxone product and education on how to recognize and treat an opioid overdose with naloxone.
Results/Outcomes: The initial pilot was implemented in May of 2018 at the urban site and was adopted in all eleven EDs within the health system by September of 2018. Key deliverables of this quality improvement initiative include the development of a clinical guideline outlining best-practice naloxone prescribing and distribution strategies for adolescents through adults, design of a patient take-home-naloxone kit utilizing an intranasal naloxone product intended for use by laypersons, custom patient and clinician education, and a program cost-benefit financial analysis. Since implementation, over 136 individuals have received access to naloxone during the ED encounter. Data reports demonstrate the urban pilot site has successfully ordered a naloxone product for 74% of individuals who were discharged from the ED after an opioid overdose.
Implications: Naloxone has a relatively good safety profile and the emergency visit offers a prime opportunity to provide this rescue medication and education on how to recognize and respond to an opioid overdose. Naloxone distribution may incur costs on the healthcare system; therefore seeking out supplemental funding may be an important consideration when implementing such programs. Emergency Department nurses and providers can make a significant contribution to reducing harm incurred by opioids on the community. Increasing access through naloxone distribution is one essential component to include in a comprehensive ED opioid harm reduction strategy.
Opioid Harm Reduction;
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
All permission requests should be directed accordingly and not to the Sigma Repository.
All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Showing items related by title, author, creator and subject.
Harm Reduction Strategy for Prevention/Reduction of Opioid Overdose Fatalities in the Substance Use Disorder Population L'Heureux, Susan M.; Goldstein, Nancy S.This educational activity describes the use of a harm reduction intervention/strategy for the current issue of opioid overdose fatalities in public health and its effect on perceived importance of and barriers to Naloxone/Narcan ...
L'Heureux, Susan M.; Goldstein, Nancy S.This educational activity describes the current issue of opioid overdose in public health and perceived importance of and barriers to harm reduction strategies of Naloxone/Narcan utilization among the Substance Use Disorder ...
Shipley, Sarah; Wallis, Frankie; Lovelace, Michael R.; Jones, Tamicka S.; Hardy, SherichiaPoster presentationSession J presented Wednesday, October 2, 11:30 am-12:30 pmPurpose: Opioid use in the United States is on the rise as evidenced by coining of the term the Opioid Epidemic. Effort has been put into ...
Leading the Way: Reflections From Emerging Educational Administrator Institute Leadership Journeys Sharts-Hopko, Nancy C.; Amarasekara, Thamara Dilhani; McFadden, John; D'Aoust, Rita F.; Iseler, Jackeline; Lourens, Gayle; Hagler, DebraThis session provides an overview of the Emerging Educational Administrator Institute, including the aims of the EEAI, perspectives of mentors and scholars on the experience, leadership development opportunities offered by STTI.
Pop, Hannah L.; Lamb, Karen V.; Livesay, Sarah; Altman, Patricia; Nora, MaryElizabeth; Sanchez, AndreaA successful reduction in patient falls was achieved the ED through a fall prevention bundle composed of improved fall-risk screening, multifactorial interventions, and staff education. High rates of fall risk screening ...