Results of a Naloxone Screening Quality-Improvement Project in an Academic Emergency Department

Devries, Jennifer; Rafie, Sally; Ajayi, Toluwalase; Kreshak, Allyson A.; Edmonds, Kyle P

doi:10.1016/j.jemermed.2018.12.029

Cited by 9 publications

(26 citation statements)

References 12 publications

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“…One such intervention that holds promise is electronic health record prompts, which can be triggered by terms entered into the patient’s initial assessment [49, 50]. Such interventions have been previously demonstrated to increase the distribution of THN to ED patients discharged after opioid overdoses [49, 50]. As evidenced by our study, without such systematic approaches, attaining complete coverage of even the highest risk patients is difficult when implementing ED-based THN programs.…”

Section: Discussionmentioning

confidence: 97%

“…Future evaluations are needed to examine the extent to which these different patients can be targeted, and to develop systematic protocols to identify various individuals at risk of overdose. One such intervention that holds promise is electronic health record prompts, which can be triggered by terms entered into the patient’s initial assessment [49, 50]. Such interventions have been previously demonstrated to increase the distribution of THN to ED patients discharged after opioid overdoses [49, 50].…”

Section: Discussionmentioning

confidence: 99%

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Patient characteristics associated with being offered take home naloxone in a busy, urban emergency department: a retrospective chart review

O’Brien

Dabbs

Dong

et al. 2019

BMC Health Serv Res

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Background Overdose deaths can be prevented by distributing take home naloxone (THN) kits. The emergency department (ED) is an opportune setting for overdose prevention, as people who use opioids frequently present for emergency care, and those who have overdosed are at high risk for future overdose death. We evaluated the implementation of an ED-based THN program by measuring the extent to which THN was offered to patients presenting with opioid overdose. We analyzed whether some patients were less likely to be offered THN than others, to identify areas for program improvement. Methods We retrospectively reviewed medical records from all ED visits between April 2016 and May 2017 with a primary diagnosis of opioid overdose at a large, urban tertiary hospital located in Alberta, Canada. A wide array of patient data was collected, including demographics, opioid intoxicants, prescription history, overdose severity, and whether a naloxone kit was offered and accepted. Multivariable analyses were used to identify patient characteristics and situational variables associated with being offered THN. Results Among the 342 ED visits for opioid overdose, THN was offered in 49% ( n = 168) of cases. Patients were more likely to be offered THN if they had been found unconscious (Adjusted Odds Ratio 3.70; 95% Confidence Interval [1.63, 8.37]), or if they had smoked or injected an illegal opioid (AOR 6.05 [2.15,17.0] and AOR 3.78 [1.32,10.9], respectively). In contrast, patients were less likely to be offered THN if they had a current prescription for opioids (AOR 0.41 [0.19, 0.88]), if they were admitted to the hospital (AOR 0.46 [0.22,0.97], or if they unexpectedly left the ED without treatment or before completing treatment (AOR 0.16 [0.22, 0.97). Conclusions In this real-world evaluation of an ED-based THN program, we observed that only half of patients with opioid overdose were offered THN. ED staff readily identify patients who use illegal opioids or experience a severe overdose as potentially benefitting from THN, but may miss others at high risk for future overdose. We recommend that hospital EDs provide additional guidance to staff to ensure that all eligible patients at risk of overdose have access to THN.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Patient characteristics associated with being offered take home naloxone in a busy, urban emergency department: a retrospective chart review

O’Brien

Dabbs

Dong

et al. 2019

BMC Health Serv Res

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“…Studies focusing on opioid overdose included patients with a documented history of opioid overdose 27 or those with a self-report of overdose since previous ED discharge. 19 Others assessed opioid overdose on the basis of the inability to conduct screening because of altered mental state 17 and decreased mental status or respiratory depression necessitating the use of naloxone before or during the ED visit.…”

Section: Opioid Overdosementioning

confidence: 99%

“…Their BI also focused on suggested treatment options based on insurance coverage, residence, and preferences. 11 Educational interventions focused on opioid overdose prevention, including use of naloxone, 19,20,27 or on buprenorphine. 21,25 Dwyer et al 19 employed ED-based licensed alcohol and drug counselors to deliver a 5-minute overdose educational intervention, composed of overdose risks, how to recognize and respond to a witnessed overdose by calling 911, delivering rescue breaths, and staying with the individual until the emergency response team arrived.…”

Section: Brief Intervention and Educationmentioning

confidence: 99%

“…Four studies in which naloxone was provided at discharge from the emergency department reported that it was either prescribed 27 or freely provided. 19,20 The contents of the naloxone kits varied and included either 2 mg naloxone vials 19 or 2 doses of 2 mg of intranasal naloxone, a mucosal atomizer device, and pictorial with written assembly and administration instructions in English and Spanish.…”

Section: Naloxone Prescriptionmentioning

confidence: 99%

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Recommendations for Emergency Departments Caring for Persons with Opioid Use and Opioid Use Disorders: An Integrative Review

Slater¹,

Rodney²,

Kozachik³

et al. 2022

Journal of Emergency Nursing

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The main findings of this paper are the best practices for (1) Screening: identifying and assessing persons who are at risk because of opioid use, (2) Brief intervention: delivering motivationally based interventions, (3) Pharmacotherapy: providing access to buprenorphine and naloxone, (4) Referral to treatment: making a referral to specialty treatment, and (5) Follow-up and monitoring: confirming that the patient is linked to treatment and outcomes are being monitored.

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Naloxone distribution programs in the emergency department: A scoping review of the literature

Sindhwani,

Friedman,

O'Donnell

et al. 2024

JACEP Open

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This scoping review summarized the literature regarding naloxone distribution from emergency departments (EDs) without a prescription. Our intention was to examine various naloxone distribution programs, their methodologies, and the level of effectiveness of each. Understanding these key aspects of naloxone distribution could lead to improved standardized protocols, saving countless additional lives from opioid overdose. This review evaluated studies reporting naloxone distribution from EDs in the United States. The included studies were written in English and published between January 1, 2017, and December 31, 2022. Searches were performed using PubMed and Embase. A total of 129 studies were reviewed, with only 12 meeting the necessary criteria for analysis. Heterogeneity was found across naloxone distribution programs, including how patients were identified, how naloxone was dispensed to patients, and the specific naloxone products made available. The protocols included various methods, such as patient screening, where information used for this screening was sometimes obtained from health records or patient interviews. Some programs detailed only the distribution of naloxone, while others included additional interventions such as behavior counseling, peer support, and education. In four studies, patients received buprenorphine with naloxone kits. The various programs differed in their implementation but were generally successful in improving naloxone distribution. However, among the studies reviewed, the percentage of ED patients receiving naloxone varied from ∼30% to 70%, suggesting that certain program elements may be more impactful. Further research is needed to identify key elements of the most impactful programs in order to improve naloxone distribution and improve patient odds of surviving an opioid overdose.

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Results of a Naloxone Screening Quality-Improvement Project in an Academic Emergency Department

Cited by 9 publications

References 12 publications

Patient characteristics associated with being offered take home naloxone in a busy, urban emergency department: a retrospective chart review

Patient characteristics associated with being offered take home naloxone in a busy, urban emergency department: a retrospective chart review

Recommendations for Emergency Departments Caring for Persons with Opioid Use and Opioid Use Disorders: An Integrative Review

Naloxone distribution programs in the emergency department: A scoping review of the literature

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