Patient Teaching about Naloxone in the Emergency Department: The Creation and Implementation of a Clinical Practice Guideline

Background: Opioid overdose is the leading cause of preventable death in the Utah, and nationally. Utah ranks seventh in the nation for opioid overdose deaths with eight deaths weekly. Fatalities have continued to rise dramatically for over thirty years. Intensified by the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) reports a 30% surge increase in overdose deaths occurring in 2020 compared to 2019. Opioids are reversible with opioid antagonists, such as naloxone. The CDC, US Food and Drug Administration (FDA), and Surgeon General recommend all patients taking opioids be taught about naloxone. This teaching was lacking at the South Jordan University of Utah Emergency Department (SJED). Methods: A quality improvement (QI) project was developed to provide awareness of opioid overdose risk and the reversal agent naloxone for all opioid using patients seen at SJED. This was a multi-step process starting with a pre-survey to assess clinical staff attitudes and knowledge about naloxone teaching. Simultaneously, a focus group questionnaire was sent seeking feedback from stakeholders for input about creating a new clinical practice guideline (CPG). A CPG, dot phrase, and discharge teaching resource were created. An educational presentation was provided in-person to clinical staff introducing the use of this tool kit. After 12 weeks of implementation a post-survey was collected, and pre and post chart data were evaluated. The CPG and discharge resources were designed to avoid implicit bias toward opiate users/misusers. Results: The project generated a new practice. In the 12 weeks prior to this project, there were no documented cases of patients who received naloxone teaching and resources. In the 12 weeks after implementation there were 92 documented instances of patient naloxone teaching. A comparison of select pre and post survey questions showed knowledge improvement in the following areas: CDC, FDA, & Surgeon General recommendations; increased confidence knowing what information to teach; and increased comfort level in naloxone teaching. Conclusions: This educational presentation, CPG, and tool kit appeared to promote the naloxone patient teaching recommended by the CDC, FDA, and Surgeon General. The project results were provided to key stakeholders to encourage use of this CPG at the University main emergency department as well as all University of Utah clinics. Additionally, naloxone teaching should be provided for inpatients at discharge who are newly prescribed, or chronically using, opioids.