(1389) Healthcare-Wide Deployment of Intranasal Naloxone

Introduction: Naloxone is an opioid antagonist indicated for the emergent treatment of known or suspected opioid overdose. Naloxone works quickly and should be rapidly after signs and symptoms of possible opioid overdose are identified. Several commercially available delivery methods exist, such as prefilled syringes, nasal atomizers, and solution for injection. Most inpatient formulary options are meant to be given via intravenously (IV), intramuscularly (IM), or subcutaneously (SC). Intranasal (IN) naloxone administration may be facilitated via an atomizer attachment to a syringe or utilization of a naloxone nasal spray device. The FDA recently approved an over the counter device, but most inpatient settings do not have this device on formulary and atomizers are currently on national shortage. While naloxone vials/carpujects can be administered IM, this route also requires additional materials, training, and potentially the removal of clothing. Additionally, naloxone is not routinely available in public areas or the ambulatory care setting. In an effort to overcome these barriers, our organization made IN naloxone devices available throughout the healthcare system to facilitate swift administration by staff or bystanders when an emergent overdose is suspected.

Methods: All code carts, rapid response medication bags, and automated external defibrillators (AEDs) throughout the institution were identified and intranasal naloxone was to be stocked in those locations. Security officers who respond to campus wide events were also approached to carry IN naloxone. All inpatient pharmacists, rapid response team members, medical providers, hospital staff, and security officers were educated about the addition, location, indication, and how to administer IN naloxone devices. Providers were educated to utilize the IV route when available, and to utilize IN naloxone when not available.

Results: IN naloxone has been dispensed to 182 code carts and 48 AEDs throughout the enterprise for use in inpatients and visitors. IN naloxone was made available in both the adult and pediatric areas in the acute care setting, public areas, and ambulatory clinics across the state.

Conclusions: IN naloxone is now widely available for utilization in patients or visitors with suspected opioid overdose when IV access is not available.