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全州范围内急诊科纳洛酮带离项目试点:改善阿片类药物过量风险患者的护理质量。

Piloting a statewide emergency department take-home naloxone program: Improving the quality of care for patients at risk of opioid overdose.

机构信息

Department of Emergency Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA.

Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA.

出版信息

Acad Emerg Med. 2022 Apr;29(4):442-455. doi: 10.1111/acem.14435. Epub 2022 Jan 28.

Abstract

BACKGROUND

Emergency department (ED) patients with nonfatal opioid overdose are at high risk for subsequent fatal overdose, yet ED programs aimed at reducing harm from opioid use remain underdeveloped.

OBJECTIVES

The objective was to pilot a statewide ED take-home naloxone program and improve the care of patients with opioid use disorder (OUD) and risky drug use through training and interprofessional network building.

METHODS

Nine hospital EDs with pharmacy, nurse, and physician champions were recruited, surveyed, and trained. Take-home naloxone rescue kits were developed, disseminated, and tracked. Two overdose prevention summits were convened prior to the COVID pandemic, and two X-waiver training courses aimed at emergency physicians and advanced practice providers were arranged, both in person and virtual.

RESULTS

A total of 872 naloxone rescue kits were distributed to ED patients at risk of opioid overdose during the first phase of this project, and more than 140 providers were trained in the use of medications for OUD in acute care settings.

CONCLUSIONS

A statewide ED take-home naloxone program was shown to be feasible across a range of different hospitals with varying maturity in preexisting OUD resources and capabilities. Future work will be aimed at both expanding and measuring the effectiveness of this work.

摘要

背景

非致命性阿片类药物过量的急诊科(ED)患者有很高的后续致命性药物过量风险,但旨在减少阿片类药物使用造成的伤害的 ED 项目仍未得到充分发展。

目的

通过培训和跨专业网络建设,试点全州 ED 患者带离纳洛酮项目,并改善阿片类药物使用障碍(OUD)和危险药物使用患者的护理。

方法

招募了 9 家拥有药剂师、护士和医生支持者的医院 ED 进行调查和培训。开发、分发和跟踪带离纳洛酮急救包。在 COVID 大流行之前,召开了两次预防过量峰会,并安排了两次 X 豁免培训课程,旨在为急诊医师和高级实践提供者提供有关急性护理环境中 OUD 药物使用的培训,包括面对面和虚拟课程。

结果

在该项目的第一阶段,共向有阿片类药物过量风险的 ED 患者分发了 872 个纳洛酮急救包,并培训了 140 多名在急性护理环境中使用 OUD 药物的提供者。

结论

全州 ED 患者带离纳洛酮项目在不同医院均具有可行性,这些医院在 OUD 资源和能力方面存在差异。未来的工作将致力于扩大和衡量这项工作的有效性。

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