Development and Evaluation of a Pilot Overdose Education and Naloxone Distribution Program for Hospitalized General Medical Patients

Abstract

Background Overdose education and naloxone distribution (OEND) to people at risk of witnessing or experiencing an opioid overdose has traditionally been provided through harm reduction agencies. Expanding OEND to inpatient general medical settings may reach at-risk individuals who do not access harm reduction services and have not been trained. An OEND program targeting inpatients was developed, piloted, and evaluated on two general medicine floors at Montefiore Medical Center, a large urban academic medical center in the Bronx, NY. Methods The planning committee consisted of ten resident physicians and two faculty mentors. A consult service model was piloted, whereby the primary inpatient care team paged the consult team (consisting of rotating members from the planning committee) for any newly admitted patient who had used any opioid in the year prior to admission. Consult team members assessed patients for eligibility and provided OEND to eligible patients through a short video training. Upon completion, patients received a take-home naloxone kit. To evaluate the program, a retrospective chart review over the first year (April 2016 -March 2017) of the pilot was conducted. Results Overall, consults on 80 patients were received. Of these, 74 were eligible and the consult team successfully trained 50 (68%). Current opioid analgesic use of ≥50 morphine milligram equivalents daily was the most common eligibility criterion met (38%). Twenty-four percent of patients were admitted for an opioid-related adverse event, the most common being opioid overdose (9%), then opioid withdrawal (8%), skin complication related to injecting (5%), and opioid intoxication (2%). Twenty-five percent had experienced an overdose, 35% had witnessed an overdose in their lifetime, and 83% had never received OEND previously. Conclusions Integrating OEND into general inpatient medical care is possible and can reach high-risk patients that have not received OEND previously. Future research should identify the optimal way of implementing this service.

A Healthcare System‐Level Intervention to Increase Naloxone Availability for Patients With Opioid Prescriptions

“…Other health systems have created programs intended to increase naloxone co‐prescribing and distribution. These programs have relied on providers or other users to identify patients who would benefit from naloxone and reach out to additional resources through the use of chart review by pharmacists or via clinical dashboard review 15‐17 . One organization reported the use of an inline alert to encourage co‐prescribing of naloxone but did not report on the efficacy of this intervention 16 …”

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

“…To the best of our knowledge, this is the second statewide, interhospital network ED take‐home naloxone rescue kit program developed in the United States 29 . Hospital collaborations between pharmacists, physicians, and nurses have been successful in creating naloxone programs in ED, 22 other outpatient, 30 and inpatient programs 31 …”

“…29 Hospital collaborations between pharmacists, physicians, and nurses have been successful in creating naloxone programs in ED, 22 other outpatient, 30 and inpatient programs. 31 We were able to successfully leverage expertise in opioid harm reduction, quality improvement, and internetwork ED collaboration to create a successful pilot project that has distributed nearly 900 naloxone rescue kits to ED patients at risk of opioid overdose in its first year.…”

Community Case Study of Naloxone Distribution by Hospital-Based Harm Reduction Program for People Who Use Drugs in New York City

“…A pilot study developed a four-step program for OEND at The Veterans Health Administration (VHA) that focused on identifying target populations, garnering support, training staff members, and implementation ( Peckham and Boggs, 2016 ). Inpatient medical OEND integration was explored in another pilot study that enrolled newly admitted patients who had used opioids in the year before admission, exposed them to a short training video, and gave them a take-home naloxone supply ( Jakubowski et al, 2019 ).…”

“…The pilot study examining OEND among hospital inpatients also described limited hospitalization times as a barrier to effectively training all inpatients. Furthermore, they proposed expanding the classification of opioid-related events as a universal assessment rather than targeting only those admitted with opioid-related diagnoses to broaden the eligible pool of participants ( Jakubowski et al, 2019 ).…”