Devries Jennifer, Rafie Sally, Ajayi Toluwalase A, Kreshak Allyson, Edmonds Kyle P
School of Medicine, University of California San Diego, La Jolla, California.
Department of Pharmacy, University of California San Diego Health, San Diego, California.
J Emerg Med. 2019 Apr;56(4):378-385. doi: 10.1016/j.jemermed.2018.12.029. Epub 2019 Feb 13.
The Emergency Department (ED) is a medical setting increasingly utilized by opioid users. In January 2016, our health system initiated a take-home naloxone education and distribution program. From July to August 2016, screening was performed in the ED to identify patients for take-home naloxone.
To evaluate the outcomes of routine screening for take-home naloxone in the ED setting and to determine key screening questions. Secondary analysis of Electronic Health Records for discrete elements that could help identify individuals for naloxone.
This is a single-center, retrospective cohort study conducted at two EDs within an academic health system. A screening tool was verbally administered to a convenience sample of ED patients as part of a pilot project to identify patients for overdose education and naloxone. Patient charts were reviewed retrospectively for pre-determined historical elements, medications prescribed, and substance use history. Descriptive and comparative analysis using Fisher two-tailed tests were performed with regard to historical elements, naloxone recommendation and prescription.
A total of 182 patients were included. Following screening, 58 (31.9%) were identified as candidates for take-home naloxone. Of those, 36 (62.1%) accepted naloxone recommendation and 19 (32.8%) were prescribed naloxone. Individuals not prescribed naloxone despite recommendation either declined naloxone 22 (37.9%) or were not prescribed naloxone 17 (29.3%). Subanalysis of questions with binary yes/no answers (N = 171) demonstrated significant prediction of both naloxone recommendation (ROC = 0.944) and prescription (ROC = 0.897).
Routine screening for take-home naloxone can help identify patients at-risk for opioid overdose and increase naloxone access in the ED.
急诊科（ED）越来越多地被阿片类药物使用者所利用。2016年1月，我们的医疗系统启动了一项纳洛酮带回家教育和分发计划。2016年7月至8月，在急诊科进行了筛查，以确定适合接受纳洛酮带回家的患者。
评估在急诊科环境中对纳洛酮带回家进行常规筛查的结果，并确定关键的筛查问题。对电子健康记录进行二次分析，以获取有助于识别适合使用纳洛酮的个体的离散元素。
这是一项在学术医疗系统内的两个急诊科进行的单中心回顾性队列研究。作为一项试点项目的一部分，对急诊科患者的便利样本进行了口头筛查工具测试，以识别适合接受过量用药教育和纳洛酮的患者。对患者病历进行回顾性审查，以获取预先确定的历史元素、所开药物和物质使用史。对历史元素、纳洛酮推荐和处方进行了描述性和比较性分析，并使用费舍尔双尾检验。
共纳入182例患者。筛查后，58例（31.9%）被确定为适合接受纳洛酮带回家的候选人。其中，36例（62.1%）接受了纳洛酮推荐，19例（32.8%）被开具了纳洛酮。尽管被推荐但未被开具纳洛酮的个体中，22例（37.9%）拒绝了纳洛酮，17例（29.3%）未被开具纳洛酮。对二元是/否回答的问题（N = 171）进行的亚分析表明，对纳洛酮推荐（ROC = 0.944）和处方（ROC = 0.897）都有显著预测。
对纳洛酮带回家进行常规筛查有助于识别阿片类药物过量风险患者，并增加急诊科的纳洛酮获取。
