Dear Providers at SFGH –
I am writing on behalf of a committee here at SFGH to tell you about an exciting opportunity. Given reports of increasing numbers of deaths from unintentional overdose due to opioids, we can now offer intra-nasal naloxone to hospitalized patients that may be at increased risk for overdose. This has already begun in the General Medicine and Family Health Center Clinics, and now hospitalized patients can also be given this potentially life-saving medicine.
For those that may not be familiar with naloxone – it is an opioid receptor antagonist that rapidly reverses the effects of excessive opioid (eg, respiratory depression). It is a safe, fast, and effective medication that has been distributed for years to heroin users, resulting in dramatic decreases in death from overdose. Naloxone comes in a pre-filled syringe (via a prescription), but you need to attach an atomizer to the syringe to allow it to be sprayed up a patients nose (see below picture). Our discharge pharmacy will be stocking this medication and the atomizer for our patients.
As part of this pilot effort, there are 3 groups of patients that are eligible for the medication:
- Any patient with a history of overdose
- Patients on chronic opioids at risk of misuse or overdose
- Patients with a current opioid use disorder
This pilot will begin with patients hospitalized on the Medicine (FIS and FRS) and Family Medicine services.
The basic procedure:
- Provider(s) identify eligible patient and sends the prescription to discharge pharmacy. Given our outstanding multi-disciplinary care here, it is expected that nursing, social work, and pharmacy will identify many eligible patients.
- Provider writes an order for the nurse to teach the patient (“Please do intra-nasal narcan teaching prior to discharge”). Place this order as soon as possible so nursing has sufficient time.
- Med-surg nurses will teach the patient and his/her caregiver how to use the medication
- Patient picks up the medication and “kit” (booklet and atomizer) from discharge pharmacy (note: naloxone can also be picked up from several outside pharmacies as well, but not the atomizer, so we encourage pick up at discharge pharmacy)
There will be education efforts within Family Medicine and Internal Medicine to provide more guidance on this important topic. Please click on this link: SFDPH Naloxone Training for Providers_Gaspar from James Gaspar at CBHS pharmacy for additional information on overdose and naloxone.
Finally, we welcome any and all feedback as this pilot begins.
- Soraya Azari
- Elena Tinloy
- Swati Patel
- Diana Coffa
- Piera Wong
- Anita Roberts
- Justin Dauterman
- Philip Coffin
- Lindsay Ryan
- Liz Imbert
- Joe Hippensteel