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Simul Healthc. 2017 Feb;12(1):22-27. doi: 10.1097/SIH.0000000000000182.

Patient Simulation for Assessment of Layperson Management of Opioid Overdose With Intranasal Naloxone in a Recently Released Prisoner Cohort.

Author information

1
From the Department of Emergency Medicine (L.K., T.C.G.), Alpert Medical School of Brown University, Providence, RI; Lifespan Medical Simulation Center (L.K.), Providence, RI; Department of Epidemiology (T.C.G., J.D.R.), School of Public Health, Brown University, Providence; Center for Prisoner Health and Human Rights (T.C.G., S.E.B., M.S.M., J.D.R.), The Miriam Hospital, Providence, RI; Department of Emergency Medicine (S.E.B.), Alpert Medical School of Brown University, Providence, RI; Department of Medicine (M.C.R., M.S.M., J.R.D.), Alpert Medical School of Brown University; Providence, RI.

Abstract

INTRODUCTION:

Investigators applied simulation to an experimental program that educated, trained, and assessed at-risk, volunteering prisoners on opioid overdose (OD) prevention, recognition, and layperson management with intranasal (IN) naloxone.

METHODS:

Consenting inmates were assessed for OD-related experience and knowledge then exposed on-site to standardized didactics and educational DVD (without simulation). Subjects were provided with IN naloxone kits at time of release and scheduled for postrelease assessment. At follow-up, the subjects were evaluated for their performance of layperson opioid OD resuscitative skills during video-recorded simulations. Two investigators independently scored each subject's resuscitative actions with a 21-item checklist; post hoc video reviews were separately completed to adjudicate subjects' interactions for overall benefit or harm.

RESULTS:

One hundred three prisoners completed the baseline assessment and study intervention and then were prescribed IN naloxone kits. One-month follow-up and simulation data were available for 85 subjects (82.5% of trained recruits) who had been released and resided in the community. Subjects' simulation checklist median score was 12.0 (interquartile range, 11.0-15.0) of 21 total indicated actions. Forty-four participants (51.8%) correctly administered naloxone; 16 additional subjects (18.8%) suboptimally administered naloxone. Nonindicated actions, primarily chest compressions, were observed in 49.4% of simulations. Simulated resuscitative actions by 80 subjects (94.1%) were determined post hoc to be beneficial overall for patients overdosing on opioids.

CONCLUSIONS:

As part of an opioid OD prevention research program for at-risk inmates, investigators applied simulation to 1-month follow-up assessments of knowledge retention and skills acquisition in postrelease participants. Simulation supplemented traditional research tools for investigation of layperson OD management.

PMID:
28146450
PMCID:
PMC5300264
DOI:
10.1097/SIH.0000000000000182
[Indexed for MEDLINE]
Free PMC Article

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