J Am Pharm Assoc (2003). 2020 Nov-Dec;60(6):e324-e331. doi: 10.1016/j.japh.2020.06.017. Epub 2020 Jul 18.
To describe the development of an ED-based take-home naloxone (THN) program in which naloxone kits are dispensed directly to patients during ED discharge.
Our THN program was carried out at an urban academic hospital in downtown Chicago, IL. The THN kits consisted of 3 vials of 0.4-mg naloxone and 3 sterile syringes and needles for intramuscular delivery. Any member of the ED team (e.g., physician, pharmacist, or nurse) could recommend naloxone dispensing for a patient; however only the treating ED physician served as the prescriber for record. The ED pharmacist provided bedside education on recognizing opioid overdose and administering naloxone. The naloxone kit was dispensed to the patient at no cost.
This ED pharmacist-led naloxone dispensing model bypasses barriers to naloxone filling and ensures that patients walk out of the emergency department with naloxone in hand.
We report key metrics from the first 16 months of program implementation, including the number of ED visits for opioid overdose and THN kits dispensed. We further describe the key facilitators and barriers to program development.
Over 16 months, our emergency department had 669 unique visits for opioid overdose, and we dispensed 168 THN kits (10.5 per month). We are aware of at least 3 cases in which our THN kits were used to reverse opioid overdose. We faced key informational barriers to program development, such as a lack of knowledge regarding the allowability of ED medication dispensing, as well as financial barriers, such as the need to obtain a supply of naloxone. We also recognized the key facilitators of success, such as early engagement with hospital leadership.
Implementing a successful THN program is possible in the ED setting, and individual hospital emergency departments seeking to build their own program may benefit from our report.
描述一种基于急诊科的纳洛酮外带（THN）计划的发展，即在急诊科出院期间直接向患者发放纳洛酮套件。
我们的 THN 计划在伊利诺伊州芝加哥市中心的一家城市学术医院进行。THN 套件包括 3 瓶 0.4 毫克纳洛酮和 3 个用于肌肉注射的无菌注射器和针头。急诊科的任何团队成员（例如医生、药剂师或护士）都可以为患者推荐纳洛酮的发放；然而，只有主治急诊科医生才是开具处方的人。急诊科药剂师提供有关识别阿片类药物过量和使用纳洛酮的床边教育。纳洛酮套件免费分发给患者。
这种由急诊科药剂师主导的纳洛酮发放模式消除了纳洛酮配药的障碍，并确保患者离开急诊科时手中拿着纳洛酮。
我们报告了计划实施的头 16 个月的关键指标，包括阿片类药物过量的急诊科就诊次数和发放的 THN 套件数量。我们进一步描述了计划发展的关键促进因素和障碍。
在 16 个月的时间里，我们的急诊科有 669 例阿片类药物过量的独特就诊，我们发放了 168 个 THN 套件（每月 10.5 个）。我们至少知道 3 例我们的 THN 套件被用于逆转阿片类药物过量的情况。我们在计划发展方面面临关键的信息障碍，例如缺乏关于急诊科药物配药的可允许性的知识，以及财务障碍，例如需要获得纳洛酮的供应。我们还认识到成功的关键促进因素，例如尽早与医院领导层接触。
在急诊科环境中实施成功的 THN 计划是可行的，并且寻求建立自己计划的单个医院急诊科可能会从我们的报告中受益。
