Category: Professional Posters
Purpose: To evaluate current nursing practice and preference in the usage of naloxone, both intranasal and intramuscular, in the treatment of opioid (including heroin) overdose in an inpatient setting in a 275 bed community hospital. Current practice in the community hospital setting utilizes intramuscular naloxone in opioid overdose in both patients and visitors. With the increase in opioid overdose in both populations nursing counsel discussions focused on the optimal delivery method for naloxone, considering both efficacy and safety, as well as nursing preference.
Methods: Nursing counsel, comprised of nurse managers, nurse educators, staff level nurses, risk management and clinical pharmacy managers initiated discussion regarding treatment of opioid overdoses occurring in the inpatient setting, including patients and visitors. These discussions focused on utilization and outcomes data as well as demographically where the opioid overdoses were occurring and initial nursing feedback on patient and visitor access to and ease of treatment. Nursing counsel members agreed to more effectively and extensively survey nursing staff regarding their perceptions and preferences around the safety, efficacy, outcomes and ease of utilization of intranasal verses intramuscular naloxone in the treatment of opioid (including heroin) overdoses in patients and visitors. A brief nursing survey was developed and administered to nurses in acute care inpatient areas. Feedback from the survey was brought back to nursing counsel for consideration in the development of policy and practice changes.
Results: A literature search described safety, efficacy and cost as similar between the two dosage forms of naloxone being considered. Survey results revealed that nurses in areas where more opioid dependent and heroin addicted individuals were hospitalized preferred the option of intranasal naloxone as well as availability of the intramuscular formulation. Nurses in critical care inpatient areas did not report any desire to change current practice utilizing intramuscular naloxone only. Nurses in the emergency department indicated the need for both intranasal and intramuscular formulations given that they most often respond to opioid overdoses in visitors to the hospital.
Conclusion: Treatment of opioid overdose in the hospital setting, for both patients and visitors, continues to be a challenge for nursing staff in all areas, regardless of the acuity of the patient or the location of the visitor. Formulary and treatment algorithm changes should be considered based on nursing preferences to ensure optimal treatment of opioid overdoses consistently occurs. Since treatment costs and outcomes are similar, both formulations of naloxone should be available to nursing in all areas, regardless of the acuity of the patient population.