P-52 Implementation of a naloxone algorithm into a hospice in-patient setting

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Abstract

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.

Results

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.

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