Dash Swetaleena, Acquisto Nicole M, McElliott Joshua, Schailey Cole, Jones Courtney M C, Wood Nancy E, Conner Kenneth R, Nacca Nicholas
Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, United States of America.
Departments of Pharmacy and Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave. Box 638, Rochester, NY 14642, United States of America.
Am J Emerg Med. 2025 Feb;88:134-139. doi: 10.1016/j.ajem.2024.11.065. Epub 2024 Nov 23.
We implemented a "kit in hand" naloxone distribution program at emergency department (ED) discharge activated by electronic health record Best Practice Advisory (BPA). The purpose of this study was to evaluate naloxone kit distribution before and after implementation.
Retrospective observational study of adult ED patients with unintentional opioid overdose conducted over a six-month period. An intranasal (IN) naloxone kit in hand distribution program activated by BPA was implemented during the study period. Patient demographics and reasons eligible patients did not receive a kit are reported. Multivariable regression was performed to identify differences in patients that received naloxone or were intended to receive it compared to those that were not to identify any biases in distribution.
A total of 349 patients were included; 160 pre- (median age 39.5 years, 74.4 % males, 63.1 % white, 83.7 % non-Hispanic) and 189 post-implementation (median age 41 years, 75.7 % males, 52.9 % white, 81.5 % non-Hispanic). Pre-implementation, 109/160 (68.1 %) patients received a naloxone prescription at discharge with only 25/109 (22.9 %) confirmed to have picked up the naloxone kit and therefore a total of 25/160 (15.6 %) receiving naloxone. Post-implementation, 106/189 (56.1 %) patients left the ED with a naloxone kit in hand and 1/22 additional patients that had a prescription written were confirmed to have picked it up; therefore, a total of 107/189 (56.6 %) receiving naloxone. Reasons for not receiving a naloxone kit in the post-implementation period were patient refusal (6.3 %), patient already had naloxone (1.6 %), or a prescription was written instead (11.6 %). There were instances where kits were intended to be ordered based on clinician notes or naloxone kit was ordered but not dispensed by nursing staff. There were no differences between age, sex, race, ethnicity, or time of discharge from the ED following comparison of those where the clinician intended for the patient to receive naloxone and those where there was not intent to prescribe naloxone in the post-implementation group.
Implementation of a BPA-activated kit in hand naloxone distribution program increases the rate of successful naloxone distribution to patients presenting to the ED following unintentional opioid overdose, a subpopulation at very high risk for recurrence of overdose. Opportunities for program improvement were identified as there were instances where kits were intended to be distributed but barriers in the process existed.
我们在急诊科（ED）出院时实施了一项由电子健康记录最佳实践建议（BPA）激活的“手持试剂盒”纳洛酮分发计划。本研究的目的是评估实施前后纳洛酮试剂盒的分发情况。
对成年急诊科意外阿片类药物过量患者进行为期六个月的回顾性观察研究。在研究期间实施了由BPA激活的鼻内（IN）纳洛酮试剂盒手持分发计划。报告了患者的人口统计学信息以及符合条件但未收到试剂盒的原因。进行多变量回归以确定接受纳洛酮或打算接受纳洛酮的患者与未接受纳洛酮的患者之间的差异，以识别分发过程中的任何偏差。
共纳入349例患者；160例为实施前患者（中位年龄39.5岁，男性占74.4%，白人占63.1%，非西班牙裔占83.7%），189例为实施后患者（中位年龄41岁，男性占75.7%，白人占52.9%，非西班牙裔占81.5%）。实施前，109/160（68.1%）的患者在出院时收到了纳洛酮处方，但只有25/109（22.9%）的患者确认领取了纳洛酮试剂盒，因此共有25/160（15.6%）的患者接受了纳洛酮。实施后，106/189（56.1%）的患者手持纳洛酮试剂盒离开急诊科，另有1/22例有处方的患者确认领取了试剂盒；因此，共有107/189（56.6%）的患者接受了纳洛酮。实施后未收到纳洛酮试剂盒的原因包括患者拒绝（6.3%）、患者已有纳洛酮（1.6%）或开具了处方（11.6%）。存在根据临床医生记录打算订购试剂盒但护理人员未订购或订购后未发放的情况。在实施后组中，比较临床医生打算让患者接受纳洛酮的患者和不打算开具纳洛酮处方的患者，在年龄、性别、种族、民族或急诊科出院时间方面没有差异。
实施由BPA激活的手持纳洛酮试剂盒分发计划可提高向急诊科意外阿片类药物过量患者成功分发纳洛酮的比例，这些患者是过量用药复发风险非常高的亚人群。由于存在试剂盒打算分发但过程中存在障碍的情况，确定了计划改进的机会。
