Mullennix Stephanie C, Iseler Jackeline, Kwiatkowski Gregory M, McCann-Spry Lisa, Skinner Jeffrey, Kuhl Nicholas, VanDePol Eric Keith, Poland Cara Anne
Author Affiliations: Clinical Nurse Specialist (Ms Mullennix), Spectrum Health, Grand Rapids, Michigan; Director of the Clinical Nurse Specialist Program (Dr Iseler), Michigan State University College of Nursing; Clinical Pharmacy Lead - Emergency Medicine (Dr Kwiatkowski), Spectrum Health; Orthopaedic Clinical Nurse Specialist (Ms McCann-Spry), Spectrum Health; Nurse Manager (Mr Skinner), Spectrum Health; Executive Emergency Medicine Medical Director (Dr Kuhl), Spectrum Health; Emergency Medicine Physician (Dr VanDePol), Spectrum Health; and Addiction Medicine Medical Director (Dr Poland), Spectrum Health, Grand Rapids, Michigan.
Clin Nurse Spec. 2020 May/Jun;34(3):116-123. doi: 10.1097/NUR.0000000000000515.
This article describes the implementation of a clinical nurse specialist-led emergency department overdose education and naloxone distribution program. The program's purpose is to increase naloxone availability to reduce opiate overdose mortality rates within the local community.
The program distributes naloxone kits to patients in the emergency department after an opioid overdose. The kits are designed to help recipients prevent, recognize, and respond to an opioid overdose.
The program, which includes naloxone take-home kits and clinical guidelines outlining a standard of care for naloxone distribution and coprescribing, was successfully implemented across 11 emergency departments within an integrated health system. More than 250 kits were dispensed within the first year of program implementation along with an online patient education video that received more than 1600 views. In 2017, the county reported an opioid-related overdose death rate of 16.5 (per 100 000 residents). From January 2018 to June 2019, the opioid-related death rate per 100 000 residents was reported at 9.6.
Although emergency department naloxone distribution programs are feasible in the acute care setting, it was critical for clinical nurse specialists to enlist an interdisciplinary team and engage executive leadership to ensure program success. For others considering such a program, early consideration should be given to determining financial support and evaluating the compliance and regulatory aspects of dispensing medications from emergency settings.
本文描述了一项由临床护理专家主导的急诊科过量用药教育及纳洛酮分发项目的实施情况。该项目的目的是增加纳洛酮的可及性，以降低当地社区阿片类药物过量致死率。
该项目在急诊科对阿片类药物过量患者分发纳洛酮试剂盒。这些试剂盒旨在帮助接受者预防、识别和应对阿片类药物过量情况。
该项目包括纳洛酮带回家试剂盒以及概述纳洛酮分发和联合处方护理标准的临床指南，已在一个综合医疗系统内的11个急诊科成功实施。在项目实施的第一年就分发了250多个试剂盒，同时还有一个在线患者教育视频，观看次数超过1600次。2017年，该县报告的阿片类药物相关过量死亡率为每10万居民16.5例。从2018年1月到2019年6月，每10万居民的阿片类药物相关死亡率报告为9.6例。
尽管急诊科纳洛酮分发项目在急性护理环境中是可行的，但临床护理专家争取跨学科团队并让行政领导层参与以确保项目成功至关重要。对于其他考虑开展此类项目的人来说，应尽早考虑确定资金支持，并评估从急诊科分发药物的合规性和监管方面。
