Riazi Farah, Toribio Wilma, Irani Emaun, Hughes Terence M, Huxley-Reicher Zina, McBratney Elisa, Vu Trang, Sigel Keith, Weiss Jeffrey J
Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Front Sociol. 2021 Jul 7;6:619683. doi: 10.3389/fsoc.2021.619683. eCollection 2021.
In 2017, The Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program at Mount Sinai Hospital became a registered Opioid Overdose Prevention Program (OOPP) and received funding from the New York City Department of Health and Mental Hygiene to develop a program to provide overdose education and naloxone distribution (OEND) training to at risk population and bystanders. We report on the programmatic quality improvement initiatives conducted. From April 2017 to December 2020, the REACH OOPP conducted 290 opioid overdose reversal trainings, throughout the Mount Sinai Health System and in multiple other community settings. OEND training was at times offered alone and in other settings alongside Hepatitis C Virus point of care testing. Additionally, a "train the trainer" model was implemented whereby medical students and nurses at outpatient clinics were trained to train others. There were 4235 naloxone kits distributed to 3,906 participants. The training venues included hospital settings (patients and medical staff), public events, substance use programs, educational facilities, homeless prevention programs, faith-based organizations, alternative to incarceration programs, and community-based organizations. We implemented two types of training. During outreach sessions, we utilized one-on-one personalized sessions to train bystanders. When training clinic staff in the "train the trainer" model we utilized a standardized didactic presentation with slides. The two top reasons participants reported for being trained were "Just in case I see someone overdose" (59.3%) and "I'm worried that someone I know will overdose OR that I will overdose" (20.2%). The REACH program at Mount Sinai Hospital developed an effective model to train community bystanders and health care staff by leveraging administrative support and building on broader programmatic initiatives to promote drug user health and stigma-free care for people who use drugs. Hospitals do not currently mandate staff training or keeping naloxone stocked at inpatient units or outpatients clinics posing a challenge when implementing an OEND program in this setting. A recommended policy change needed to decrease overdose deaths is for hospitals to be required to implement systematic naloxone education and access for all health care personal and at risk patients.
2017年，西奈山医院的“尊重与公平获得全面医疗保健（REACH）计划”成为注册的阿片类药物过量预防计划（OOPP），并获得纽约市卫生和精神卫生部门的资金，以制定一项计划，为高危人群和旁观者提供过量用药教育和纳洛酮分发（OEND）培训。我们报告了所开展的项目质量改进举措。2017年4月至2020年12月期间，REACH OOPP在整个西奈山医疗系统及多个其他社区场所开展了290次阿片类药物过量逆转培训。OEND培训有时单独提供，在其他场所则与丙型肝炎病毒即时检测一起进行。此外，还实施了“培训培训师”模式，即对门诊诊所的医学生和护士进行培训，使其能够培训其他人。共向3906名参与者分发了4235个纳洛酮试剂盒。培训场所包括医院环境（患者和医护人员）、公共活动、药物使用项目、教育机构、无家可归者预防项目、基于信仰的组织、替代监禁项目以及社区组织。我们实施了两种类型的培训。在外展活动中，我们利用一对一的个性化课程培训旁观者。在以“培训培训师”模式培训诊所工作人员时，我们使用了带有幻灯片的标准化教学演示。参与者报告的接受培训的两大主要原因是“以防我看到有人过量用药”（59.3%）和“我担心我认识的人会过量用药或我自己会过量用药”（20.2%）。西奈山医院的REACH计划通过利用行政支持并在更广泛的项目举措基础上，建立了一个有效的模式来培训社区旁观者和医护人员，以促进吸毒者的健康并为吸毒者提供无污名化护理。医院目前并未强制要求员工培训或在住院部或门诊诊所储备纳洛酮，这在这种环境下实施OEND计划时构成了挑战。减少过量用药死亡所需的一项建议政策改变是要求医院为所有医护人员和高危患者实施系统性的纳洛酮教育并提供纳洛酮。
