RT Journal Article
SR Electronic
T1 P-52 Implementation of a naloxone algorithm into a hospice in-patient setting
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP A19
OP A19
DO 10.1136/bmjspcare-2017-00133.52
VO 7
IS Suppl 1
A1 Sills, Emily
A1 Lawrence, Clare
YR 2017
UL http://spcare.bmj.com/content/7/Suppl_1/A19.2.abstract
AB Background Naloxone is an opioid antagonist, indicated for the reversal of central nervous depression and respiratory depression, in the treatment of opioid overdose/intoxication. A National Safety Alert in 2014 (1) highlighted that doses commonly used to treat opioid overdose in the Emergency Department are not appropriate to manage opioid induced respiratory depression and sedation in the palliative care setting. There is very little published literature about the use of naloxone in the palliative care setting.Method A collective case study approach was used to guide a service development project. The clinical notes of three hospice in-patients, treated with naloxone for critical opioid induced respiratory depression and sedation, in the absence of being in the dying phase of their illness, were reviewed to identify themes and evaluate whether the management of these cases could be improved.Results An “Emergency use of naloxone for iatrogenic opioid overdose”, algorithm was developed for use on the in-patient unit. It is divided into: assess, monitor, act and aims to guide the clinician through using naloxone in a palliative care setting once the diagnosis of opioid overdose has been established.The algorithm has been introduced to the hospice through teaching sessions and has been re-evaluated, following its introduction, on three further patients in whom the algorithm guided management.Conclusion Using naloxone for iatrogenic overdose is uncommon in the hospice setting, however introduction of the algorithm has standardised assessment and ensured appropriate doses of naloxone are being used.