Providing Nasal Naloxone Spray to High Risk Emergency Department Patients
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Session E presented Friday, September 15, 2017
Purpose: To address knowledge gaps and negative attitudes towards patients with substance use disorders (SUDs) and to collect information to inform a pilot project in a hospital system to provide naloxone nasal spray for home use as well as harm-reduction education to emergency department (ED) patients at high risk for opioid overdose.
Design: An educational intervention addressing gaps in knowledge and attitudes toward ED patients at high risk for opioidoverdose. The education intervention was developed and presented collaboratively with the Director of Drug Abuse Outreach Initiatives and the Community Outreach Specialist from the state's Attorney General's Office. Content included: the history and effects of the epidemic, SUD as a medical condition, pathways from prescription opioid to heroin use, primary prevention, harm reduction strategies of providing nasal naloxone spray for home use, and treatment and recovery resources. The project received approval from a university based institutional review board (IRB) and as a Quality Improvement project from a hospital based IRB. Registered Nurses (RNs) participated in a pre and post survey to measure the impact of the education intervention.
Setting: All ED RNs working in one urban level 1 trauma center, two suburban and one rural ED in the same health care system were invited to attend one of the 11 education intervention sessions.
Participants/Subjects: Other ED staff were invited to attend but survey data was only collected for RNs.
Methods: A review of the literature described RNs having negative attitudes towards patients with SUD. The literature also demonstrated that these attitudes could be moderated by increasing knowledge of caring for patients with SUD, opioid overdose, treatment and recovery. Educational interventions addressing this gap in knowledge resulted in both improved knowledge and attitudes of RNs providing care to patients with SUDs. The education intervention in this evidence based project was designed to address these knowledge gaps. A 21 item survey was developed using questions from the Opioid Overdose Knowledge Scale and the Opioid Overdose Attitudes Scale. RNs recorded their survey responses before and after the education intervention. Thirty days following the education intervention, nurses were contacted by email to participate in a short telephone interview to provide additional information regarding the intervention and providing care to patients with SUD.
Results/Outcomes: Descriptive statistics will be used to summarize the data and a paired t-test will be performed. 75 participants attended the 11 education interventions, 57 were RNs, others included paramedics, behavioral health and social workers, and physicians. An informal review of the verbal and written feedback indicates that the education intervention provided valuable, and useful information about SUD and the need to increase access to naloxone for home use. Frequently asked questions pertained to whether providing naloxone for home use would encourage drug use, give false reassurance to patients and families, and whether other aspects of the opioid epidemic were being adequately addressed.
Implications: While survey data may not reflect the total impact of the education intervention, feedback from the RNs participating in the education intervention demonstrated a need for further education dispelling misconceptions regarding SUD as a medical condition, and their interest in providing an evidence based approach to patients with SUD. Outcomes will be used to inform a hospital system pilot project to provide naloxone nasal spray for home use as well as harm-reduction education to ED patients at high risk for opioid overdose.