Pam Davidson, Selina Fleming, Ryan Itterman, Melissa Rathwell, Tasha Vandervliet
Abstract – With a goal of supporting the efforts of local Health Units in community harm reduction strategies, one organization has piloted a program that allows nursing staff in their Emergency Departments to distribute Naloxone kits to patients at risk for opioid misuse.
Under the Ministry of Health and Long-Term Care’s (MOHLTC) Ontario Naloxone Program, Paramedics and Firefighters are able to use Naloxone kits when responding to potential opioid overdoses in the community. Take-home Naloxone kits are also available at most pharmacies or local health units for anyone who is at risk of an overdose or for those who are likely to encounter one (Government of Canada, 2019). However, once a person at risk enters the hospital setting, the Ontario Public Hospitals’ Act requires an authorizing mechanism, such as a physician’s order, prior to dispensing the same Naloxone kit being used and dispensed in the community.
The opportunity for improving access to this potentially lifesaving drug in the hospital setting was explored with the realization that in busy Emergency Departments (ED), at-risk patients are sometimes discharged, or leave on their own, before nurses have the opportunity to approach the physicians for an order for a Naloxone kit.
With a goal of supporting the efforts of local Health Units in community harm reduction strategies, the Huron Perth Healthcare Alliance (HPHA) has piloted a program that allows ED nursing staff among all four of its rural sites to distribute Naloxone kits to patients at risk for opioid misuse.
The HPHA, which includes the Clinton Public Hospital, Seaforth Community Hospital, St. Marys Memorial Hospital and Stratford General Hospital, partnered with the Huron County Health Unit and Perth District Health Unit to obtain and distribute nasal spray Naloxone kits from each of their Emergency Departments to augment community access points. As part of the agreement, the HPHA developed program-related procedures and educational resources to support the provision of Naloxone as one strategy to help prevent deaths and other adverse health effects resulting from opioid overdoses.
Using a signed Medical Directive as the authorizing mechanism, ED nurses at HPHA are now able to offer Naloxone kits to registered individuals who are at risk of opioid overdose.
Nurses are also able to offer these kits to registered family members, friends or other persons who self-identify as being in a position to assist someone at risk of overdose from opioids. To ensure Naloxone kits are accessible in all EDs 24/7 and to facilitate tracking of usage, the kits will be stored in the ED’s automated dispensing unit where they can be closely monitored. Each kit contains two intranasal Naloxone doses, basic instructions for use as well as a pamphlet (adapted for use from the Listowel Wingham Hospitals Alliance), which provides more detailed information about how to respond to a suspected opioid overdose. Prior to the individual receiving a Naloxone kit, Nurses will provide overdose prevention training - education related to overdose treatment and use of the kit. In order for ED nursing staff to be eligible to implement the directive, they are required to complete an online education module that reviews the dispensing process, medical directive and the overdose prevention training requirements.
On a quarterly basis, to satisfy MOHLTC reporting requirements, the number of individuals trained to administer naloxone (patients, family and/or friends) and the number of naloxone kits distributed to individuals (patients, family and/or friends) is provided to each of the partnering Health Units.
Naloxone kits have successfully reversed thousands of overdoses across Canada (Government of Canada, 2019). Through its Emergency Department Naloxone Kit Distribution Program, the HPHA will continue to engage its Emergency Departments along with local community health authorities to promote well-being and reduce harm among the individuals of the communities it serves.
Government of Canada. (2019). Naloxone. Retrieved from https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/naloxone.html