Development of a take-home naloxone program at an urban academic emergency department.

To describe the development of an ED-based take-home naloxone (THN) program in which naloxone kits are dispensed directly to patients during ED discharge. Our THN program was carried out at an urban academic hospital in downtown Chicago, IL. The THN kits consisted of 3 vials of 0.4-mg naloxone and 3 sterile syringes and needles for intramuscular delivery. Any member of the ED team (e.g., physician, pharmacist, or nurse) could recommend naloxone dispensing for a patient; however only the treating ED physician served as the prescriber for record. The ED pharmacist provided bedside education on recognizing opioid overdose and administering naloxone. The naloxone kit was dispensed to the patient at no cost. This ED pharmacist-led naloxone dispensing model bypasses barriers to naloxone filling and ensures that patients walk out of the emergency department with naloxone in hand. We report key metrics from the first 16 months of program implementation, including the number of ED visits for opioid overdose and THN kits dispensed. We further describe the key facilitators and barriers to program development. Over 16 months, our emergency department had 669 unique visits for opioid overdose, and we dispensed 168 THN kits (10.5 per month). We are aware of at least 3 cases in which our THN kits were used to reverse opioid overdose. We faced key informational barriers to program development, such as a lack of knowledge regarding the allowability of ED medication dispensing, as well as financial barriers, such as the need to obtain a supply of naloxone. We also recognized the key facilitators of success, such as early engagement with hospital leadership. Implementing a successful THN program is possible in the ED setting, and individual hospital emergency departments seeking to build their own program may benefit from our report.

Eswaran V ，Allen KC ，Cruz DS ，Lank PM ，McCarthy DM ，Kim HS ... -  《-》

Patient characteristics associated with being offered take home naloxone in a busy, urban emergency department: a retrospective chart review.

O'Brien DC ，Dabbs D ，Dong K ，Veugelers PJ ，Hyshka E ... -  《BMC HEALTH SERVICES RESEARCH》

Do electronic health record prompts increase take-home naloxone administration for emergency department patients after an opioid overdose?

Distribution of take-home naloxone (THN) to emergency department (ED) patients who have survived an opioid overdose (OD) could reduce future opioid mortality, but is not commonly performed. We examined whether electronic health record (EHR) prompts provided to ED physicians when discharging a patient after an OD could improve THN distribution. Interrupted time-series analysis to compare the percentage of OD patients who received THN during the 11 months before and after implementation of an EHR prompt on 18 June 2017. A total of 3492 adult patients with diagnoses of OD discharged from nine EDs in a single health system in Western Pennsylvania from July 2016 to April 2018. The EHR prompt was triggered by the presence of specific terms in the nurse's initial assessment note. The EHR displayed a pop-up window during the ED physician discharge process asking the physician to consider prescribing or providing naloxone to the patient. The comparator was 'no EHR prompt'. Measurements were based on standard criteria from ICD diagnostic codes and chief complaint keywords. In July 2016, 16.3% [95% confidence interval (CI) = 14.0, 18.5] of OD patients received THN, which decreased every month through June 2017 by 1.2% (P < 0.0001, 95% CI = 0.8,1.7). For each month post-EHR prompt there was an increase of 2.8% of OD patients receiving THN (P < 0.001, 95% CI = 2.0, 3.5). No increases occurred in the ED with the highest pre-EHR prompt THN distribution. Rates of THN distribution varied by patient age and race prior to, but not after, implementation of EHR prompts. Electronic health record prompts are associated with increased take-home naloxone distribution for emergency department patients discharged after opioid overdoses.

Marino R ，Landau A ，Lynch M ，Callaway C ，Suffoletto B ... -  《-》

Yes, not now, or never: an analysis of reasons for refusing or accepting emergency department-based take-home naloxone.

Kestler A ，Giesler A ，Buxton J ，Meckling G ，Lee M ，Hunte G ，Wilkins J ，Marks D ，Scheuermeyer F ... -  《-》

Access and Barriers to Take-Home Naloxone Use among Emergency Department Patients with Opioid Misuse in Baltimore, Maryland, USA.

Hurt BR ，Hussain A ，Aledhaim A ，Moayedi S ，Schenkel SM ，Kim HK ... -  《-》