Location
Virtual
Start Date
1-3-2024 8:00 AM
End Date
1-3-2024 3:30 PM
Keywords:
washington; swedish; edmonds
Description
Background: Washington State, mirroring a national crisis, experienced a surge in opioid-related deaths, with 17,502 fatalities from 2007 to 2021. This trend aligns with the U.S.'s broader opioid epidemic, marked by 70,000 drug overdose deaths in 2017, data show overdose deaths involving opioids increased from an estimated 70,029 in 2020 to 80,816 in 2021. Overdose deaths were from synthetic opioids, primarily fentanyl. In response, empowering registered nurses (RNs) in emergency departments (EDs) to issue Nurse-Initiated Orders (NIO) for patients to discharge from the hospital with physical naloxone pre-pack kits to be used in the community, an opioid antagonist, has been proposed as a proactive approach. Additionally, this practice is mandated by Washington State. According to SB5195 Opioid Overdose Reversal Medication – Prescribing, which went into effect January 1st, 2022, “A practitioner in a hospital emergency department must dispense opioid overdose reversal medication in compliance with section 3 ...[Section 3] a hospital shall provide a person who presents to an emergency department with symptoms of an opioid overdose, opioid use disorder, or other adverse event related to opioid use with opioid overdose reversal medication upon discharge...”
Purpose: To assess compliance with the naloxone distribution criteria under SB5195, aiming to identify gaps to improve naloxone kit distribution and reduce adverse effects of outpatient opioid overdose attempts.
Methods: A retrospective analysis of 12,264 Best Practice Advisory (BPA) alerts from the start of the naloxone pre-pack distribution BPA on January 1st, 2022, to January 1st, 2024, was conducted in a Level IV trauma center in the Greater Seattle Area. The analysis focused on evaluating adherence to naloxone distribution criteria and identifying reasons for non-compliance.
Results: Analysis of 12,264 BPA alerts revealed a range of responses: 3,958 were canceled, 3,199 overridden, 2,003 accepted but led to no subsequent action, and 1,780 had outcomes that were not recorded or known. Ultimately, only 1,324 of these alerts resulted in actual naloxone orders being placed causing an adherence rate of 10.795%.
Conclusion: The study reveals a significant gap in implementing Washington State's SB5195 requirements, particularly the ineffectiveness of Best Practice Advisory (BPA) alerts in ensuring naloxone prescriptions in emergency departments. The disparity between BPA alerts and actual naloxone orders suggests current strategies might not adequately ensure naloxone distribution to eligible patients. These findings necessitate a reevaluation of existing practices to better adhere to SB5195 and effectively combat the opioid crisis.
Implications for Practice: There is a pressing need for further investigation into the factors impeding effective naloxone distribution, despite SB5195 and the use of BPA alerts. Understanding the reasons for the frequent overriding of BPA alerts is essential for developing more effective protocols. The adoption of NIOs in emergency departments could be a promising strategy to improve naloxone distribution and reduce opioid-related deaths. By addressing these challenges and refining NIO implementation, there is potential for a substantial decrease in mortality and morbidity associated with opioid overdoses, leading to improved patient outcomes in emergency settings.
Recommended Citation
Stewart, E; Delfeld, J; McKay, J; Corhei, J; and Elliot, Kailyn, "Adherence to SB5195 Naloxone Distribution Requirements at Discharge from the Emergency Department" (2024). Providence Nursing Research Conference 2023 – Present. 17.
https://digitalcommons.providence.org/prov_rn_conf_annual/2024/posters/17
Specialty/Research Institute
Emergency Medicine
Specialty/Research Institute
Nursing
Specialty/Research Institute
Pharmacy
Included in
Emergency Medicine Commons, Nursing Commons, Pharmacy and Pharmaceutical Sciences Commons
Adherence to SB5195 Naloxone Distribution Requirements at Discharge from the Emergency Department
Virtual
Background: Washington State, mirroring a national crisis, experienced a surge in opioid-related deaths, with 17,502 fatalities from 2007 to 2021. This trend aligns with the U.S.'s broader opioid epidemic, marked by 70,000 drug overdose deaths in 2017, data show overdose deaths involving opioids increased from an estimated 70,029 in 2020 to 80,816 in 2021. Overdose deaths were from synthetic opioids, primarily fentanyl. In response, empowering registered nurses (RNs) in emergency departments (EDs) to issue Nurse-Initiated Orders (NIO) for patients to discharge from the hospital with physical naloxone pre-pack kits to be used in the community, an opioid antagonist, has been proposed as a proactive approach. Additionally, this practice is mandated by Washington State. According to SB5195 Opioid Overdose Reversal Medication – Prescribing, which went into effect January 1st, 2022, “A practitioner in a hospital emergency department must dispense opioid overdose reversal medication in compliance with section 3 ...[Section 3] a hospital shall provide a person who presents to an emergency department with symptoms of an opioid overdose, opioid use disorder, or other adverse event related to opioid use with opioid overdose reversal medication upon discharge...”
Purpose: To assess compliance with the naloxone distribution criteria under SB5195, aiming to identify gaps to improve naloxone kit distribution and reduce adverse effects of outpatient opioid overdose attempts.
Methods: A retrospective analysis of 12,264 Best Practice Advisory (BPA) alerts from the start of the naloxone pre-pack distribution BPA on January 1st, 2022, to January 1st, 2024, was conducted in a Level IV trauma center in the Greater Seattle Area. The analysis focused on evaluating adherence to naloxone distribution criteria and identifying reasons for non-compliance.
Results: Analysis of 12,264 BPA alerts revealed a range of responses: 3,958 were canceled, 3,199 overridden, 2,003 accepted but led to no subsequent action, and 1,780 had outcomes that were not recorded or known. Ultimately, only 1,324 of these alerts resulted in actual naloxone orders being placed causing an adherence rate of 10.795%.
Conclusion: The study reveals a significant gap in implementing Washington State's SB5195 requirements, particularly the ineffectiveness of Best Practice Advisory (BPA) alerts in ensuring naloxone prescriptions in emergency departments. The disparity between BPA alerts and actual naloxone orders suggests current strategies might not adequately ensure naloxone distribution to eligible patients. These findings necessitate a reevaluation of existing practices to better adhere to SB5195 and effectively combat the opioid crisis.
Implications for Practice: There is a pressing need for further investigation into the factors impeding effective naloxone distribution, despite SB5195 and the use of BPA alerts. Understanding the reasons for the frequent overriding of BPA alerts is essential for developing more effective protocols. The adoption of NIOs in emergency departments could be a promising strategy to improve naloxone distribution and reduce opioid-related deaths. By addressing these challenges and refining NIO implementation, there is potential for a substantial decrease in mortality and morbidity associated with opioid overdoses, leading to improved patient outcomes in emergency settings.
