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J Emerg Med. 2019 Apr;56(4):378-385. doi: 10.1016/j.jemermed.2018.12.029. Epub 2019 Feb 13.

Results of a Naloxone Screening Quality-Improvement Project in an Academic Emergency Department.

Author information

1
School of Medicine, University of California San Diego, La Jolla, California.
2
Department of Pharmacy, University of California San Diego Health, San Diego, California.
3
Scripps Translational Science Institute, La Jolla, California; Department of Pediatrics, University of California, San Diego, San Diego, California.
4
Department of Emergency Medicine, University of California San Diego Health, La Jolla, California.
5
Department of Pharmacy, University of California San Diego Health, San Diego, California; Doris A. Howell Palliative Teams, University of California San Diego, La Jolla, California.

Abstract

BACKGROUND:

The Emergency Department (ED) is a medical setting increasingly utilized by opioid users. In January 2016, our health system initiated a take-home naloxone education and distribution program. From July to August 2016, screening was performed in the ED to identify patients for take-home naloxone.

OBJECTIVE:

To evaluate the outcomes of routine screening for take-home naloxone in the ED setting and to determine key screening questions. Secondary analysis of Electronic Health Records for discrete elements that could help identify individuals for naloxone.

METHODS:

This is a single-center, retrospective cohort study conducted at two EDs within an academic health system. A screening tool was verbally administered to a convenience sample of ED patients as part of a pilot project to identify patients for overdose education and naloxone. Patient charts were reviewed retrospectively for pre-determined historical elements, medications prescribed, and substance use history. Descriptive and comparative analysis using Fisher two-tailed tests were performed with regard to historical elements, naloxone recommendation and prescription.

RESULTS:

A total of 182 patients were included. Following screening, 58 (31.9%) were identified as candidates for take-home naloxone. Of those, 36 (62.1%) accepted naloxone recommendation and 19 (32.8%) were prescribed naloxone. Individuals not prescribed naloxone despite recommendation either declined naloxone 22 (37.9%) or were not prescribed naloxone 17 (29.3%). Subanalysis of questions with binary yes/no answers (N = 171) demonstrated significant prediction of both naloxone recommendation (ROC = 0.944) and prescription (ROC = 0.897).

CONCLUSIONS:

Routine screening for take-home naloxone can help identify patients at-risk for opioid overdose and increase naloxone access in the ED.

KEYWORDS:

harm reduction; opioid overdose; opioids; take-home naloxone

PMID:
30770141
DOI:
10.1016/j.jemermed.2018.12.029
[Indexed for MEDLINE]

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