LifeWays Operating Procedure

Transcription

1 LifeWays Operating Procedure CHAPTER GOVERNING POLICY 5.00 Clinical Care Services 01 Clinical Care SUBJECT: 01. NARCAN (naloxone HCI) Nasal Spray EFFECTIVE DATE: 08/16/2018 REVIEWED/REVISED: NARCAN I. OVERVIEW A. Purpose: To establish guidelines regarding the use and distribution of NARCAN (naloxone HCl) Nasal Spray ( NARCAN ) by LifeWays and its Provider Network to reduce the number of fatalities which occur as a result of an opiate overdose through recognition and response. B. Intent: LifeWays will provide NARCAN to the Provider Network and outside agencies and consumers within Jackson and Hillsdale counties as requested. II. DEFINITIONS Medical Emergency an occurrence where it becomes evident that a LifeWays team member, consumer or visitor requires immediate medical assistance. NARCAN (naloxone HCl) is an opioid antagonist used for the complete or partial reversal of opioid overdose, including respiratory depression. Opiate is a medication or drug that is derived from the opium poppy or that mimics the effect of an opiate (a synthetic opiate). Opiate drugs are narcotic sedatives that depress activity of the central nervous system, reduce pain, and induce sleep. Overdose is when the body is overwhelmed by exposure to a toxic amount of a substance or combination of substances. The body becomes unable to maintain or monitor functions necessary for life, like breathing, heart rate, and body temperature. III. PROCEDURE A. Response Protocol: 1. In the event a LifeWays Member determines a situation to be a medical emergency, the following steps should be taken: a. Remain calm. b. If opioid overdose is determined, follow NARCAN directions and universal precautions. Record time staff arrived at scene of code M, time NARCAN administered and time of arrival of Emergency Medical Service (EMS) personnel. B. Signs of an Overdose: 1. Limp and unresponsive to stimulation. 2. Breathing is slow, shallow, or gurgling. 3. Skin is pale and clammy. 4. Blue lips and/or nails. Page 1 of 5

2 LifeWays Operating Procedure CHAPTER GOVERNING POLICY 5.00 Clinical Care Services 01 Clinical Care SUBJECT: 01. NARCAN (naloxone HCI) Nasal Spray EFFECTIVE DATE: 08/16/2018 REVIEWED/REVISED: C. In Case of Overdose: 1. Use NARCAN and call Code M per LifeWays Operating procedure. 2. Call report unresponsive and not breathing. 3. Start rescue breathing. 4. Give second dose in 3-5 min, if unresponsive. D. Rescue Breathing: 1. Initiate CPR, as trained. E. Evaluate/Support 1. If normal breathing resumes, roll onto side (recovery position). 2. Revived person will be in withdrawal, physically uncomfortable and may be agitated. Stay with him/her until EMS arrives. 3. NARCAN wears off in minutes, so he/she may slip back into overdose. Use second dose if still available. 4. If you must leave the person to make call, first place the person in the recovery position before leaving. a. After use of NARCAN place back in box. Follow instructions listed below after code M is cleared and exchange with Quality Improvement Executive Coordinator for a new NARCAN. b. Notify the Chief Operating Officer/designee and the LifeWays Safety Officer. (An Emergency Response Report Form must be completed.) F. After Using NARCAN 1. LifeWays staff must fill out the data fields on the back of the NARCAN box, which include: a. Location b. Street Address, City, Zip Code c. Date Dispensed d. Individual Dispensed to 2. Report NARCAN use to the Quality Improvement (QI) Executive Coordinator by end of shift. LifeWays is required to update the Mid-State Health Network (MSHN) Box NARCAN data log after use. 3. QI Executive Coordinator orders new NARCAN as used from MSHN. G. NARCAN STORAGE 1. Follow directions as recommended on the NARCAN box for appropriate storage, specifically as follows: a. Store at room temperature between 59 and 77 degrees Fahrenheit. b. Do not freeze. c. Protect from direct light. Page 2 of 5

3 LifeWays Operating Procedure CHAPTER GOVERNING POLICY 5.00 Clinical Care Services 01 Clinical Care SUBJECT: 01. NARCAN (naloxone HCI) Nasal Spray EFFECTIVE DATE: 08/16/2018 REVIEWED/REVISED: d. Excursions permitted up to 104 degrees Fahrenheit. e. If possible, shall not be stored in a room with a window. 2. Each First Aid kit shall contain: a. Two NARCAN Nasal Sprays. b. One face shield (for CPR rescue breathing). c. One pair latex gloves. 3. The Quality Improvement Executive Coordinator will maintain the inventory tracking sheet. 4. Please note that each kit has an expiration date of approximately 12 months. 5. NARCAN naloxone kits can usually be ordered and delivered within a 48 to 72-hour period. H. Training 1. All staff are required to be trained prior to distribution of NARCAN. 2. Mid-State Health Network has provided a power point Overdose Reversal Training NARCAN Nasal Spray written by Bruce Springer, M.D., MSHN s Substance Use Disorder (SUD) Medical Director and Dani Meier, Ph.D, MSHN s Chief Clinical Officer. 3. Each staff will also be given: a. The MSHN Opioid Overdose Fact Sheet; b. The ¼ sheet of resources titled You don t have to live this way, and c. The Overdose Response Procedure sheet. I. Good Samaritan 1. During a drug overdose, a quick response can save a life. However, people illegally using drugs sometimes fail to seek medical attention during an overdose for fear of alerting the police to their illegal drug use. In order to prioritize saving lives, Michigan passed a Good Samaritan law in This law provides immunity from criminal charges for people all ages who are seeking emergency medical assistance for themselves or friends as a result of a drug overdose from any illicit drug. J. Consumer s Request of Narcan 1. When a person comes to LifeWays requesting NARCAN, please take the following steps: a. Notify an Access Department staff person. b. Move to a private place if possible. c. Obtain the following information: i. Date ii. NARCAN naloxone kit number iii. Expiration Date iv. First and Last name of the individual receiving NARCAN naloxone kit d. Fill out the label on NARCAN box. Page 3 of 5

4 LifeWays Operating Procedure CHAPTER GOVERNING POLICY 5.00 Clinical Care Services 01 Clinical Care SUBJECT: 01. NARCAN (naloxone HCI) Nasal Spray EFFECTIVE DATE: 08/16/2018 REVIEWED/REVISED: e. Present to the recipient the ¼ sheet card and explain and review the information on each side. Recommend that they put this information on the fridge at home or someplace easy to remember. f. Walk through the one-page Opioid Overdose Fact Sheet with the recipient with particular attention to safe use. g. Give the recipient: i. The NARCAN ; ii. The ¼ sheet of resources titled You don t have to live this way and Overdose Response Procedure; and iii. The Opioid Overdose Fact Sheet. h. Send all information to the Quality Improvement Executive Coordinator to complete entering information into the database as necessary. K. Provider Network and Outside Agencies Request of NARCAN. 1. Agencies requesting NARCAN shall complete a LifeWays NARCAN request form and submit to the LifeWays Chief Clinical & Quality Officer (CCQO). 2. All agencies will sign this same form upon receipt of NARCAN and will also receive the following: a. The MSHN Instructions for NARCAN Distribution; b. The MSHN Overdose Reversal Training NARCAN PowerPoint; c. The MSHN Opioid Overdose Fact Sheet; d. The You Don t Need to Live This Way sheet; and e. The Overdose Response Procedure sheet. 3. For tracking purposes, LifeWays requires written request for NARCAN from each network Provider and outside agency located within Jackson or Hillsdale counties. The QI Executive Coordinator is required to update the NARCAN Database in the MSHN Box upon use as required by MSHN for tracking purposes. Please direct all NARCAN requests to: LifeWays c/o QI Executive Coordinator 1200 N. West Ave Jackson, MI L. LifeWays Community Based Services 1. All LifeWays staff that work in the community (Case Managers, Supports Coordinators, Peer Support Specialists, Mobile Crisis Staff, Transporters) shall have access to NARCAN when in the community. a. All LifeWays-owned vehicles shall have a two-dose NARCAN naloxone kit in its First Aid Kit. Page 4 of 5

5 LifeWays Operating Procedure CHAPTER GOVERNING POLICY 5.00 Clinical Care Services 01 Clinical Care SUBJECT: 01. NARCAN (naloxone HCI) Nasal Spray EFFECTIVE DATE: 08/16/2018 REVIEWED/REVISED: i. Prior to using the LifeWays vehicle, LifeWays staff must check out the First Aid Kit from the Access Department. ii. When staff exit the LifeWays vehicle, the First Aid Kit shall be brought with staff. iii. Upon return to LifeWays, LifeWays staff will remove and return the First Aid Kit to designated spot in the Access Department. b. Staff that do not use the company vehicle but travel in the community shall carry a two-dose NARCAN naloxone kit with them. 2. LifeWays Medical Services (including Physicians) and Outpatient Services should be giving NARCAN to current consumer who requested it or have a history of opioid use or currently prescribed opioids with or without other medication. a. This should occur through a warm transfer to the Access Department to provide a NARCAN naloxone kit to an open consumer. ATTACHMENTS: MSHN Instructions for NARCAN (naloxone HCI) Nasal Spray Distribution MSHN Overdose Reversal Training NARCAN PowerPoint MSHN Opioid Overdose Fact Sheet You Don t Need to Live This Way Overdose Response Procedure Emergency Response Report Form (LW/ # A) REFERENCES Audience: LifeWays Staff LifeWays Provider Network LifeWays Operating Procedures: Behavioral, Hostage, or Medical Emergency Michigan Good Samaritan Act -- MCL HISTORY Effective 08/16/2018 Reviewed/Revised: Page 5 of 5

6 INSTRUCTIONS FOR NARCAN KIT DISTRIBUTION When a person comes to the CMH requesting a Narcan kit, please take the following steps: 1. Move to a private place if possible. 2. Open website log (or pull out hardcopy log sheet). 3. Ask questions to fill out ALL fields on form. 4. Fill out the label on Narcan kit box. 5. Present to the recipient the ¼ sheet card and explain and review the information on each side. Recommend that they put this information on the fridge at home or someplace easy to remember. 6. Walk through the 1-page Opioid Overdose Fact Sheet with the recipient with particular attention to safe use. 7. Give the recipient 1) the Narcan kit, 2) the ¼ sheet and the 3) Opioid Overdose Fact Sheet to the consumer. 8. Complete entering information into the database if necessary.

7 Overdose Reversal Training Narcan Nasal Spray Dr. Bruce Springer, MSHN SUD Medical Director Dani Meier, PhD, MSHN Chief Clinical Officer With gratitude for input from: Kate Behrenwald, PA-C, Montcalm Care Network

8 SCOPE OF THE PROBLEM Since 2006, accidental deaths due to overdose have exceeded the rate of death due to car accidents Opiates are the leading cause of this spike Locally, most drug-related deaths involve at least 1 opiate Most are unintentional

9 Rising O.D. deaths from OPRs

10 Rising O.D. deaths from Heroin

11 O.D. Deaths in Michigan Prescription Opioid & Heroin Deaths Growth in Michigan Opioid OD Deaths Heroin OD Deaths

12 Old & New(er) Opiates Heroin Morphine Oxycodone Hydrocodone (Vicodin, Norco) Codeine cough syrup Demerol Opium Dilaudid U Carfentanil is 10,000 times as potent as morphine Fentanyl is up to 100 times as potent as morphine May require several doses of Naloxone Patient may require rescue breathing 911 responders can give additional doses

13 Risk factors for Overdose Reduced tolerance after period of abstinence (jail, rehab, recovery, naltrexone treatment) Mixing drugs (alcohol, benzodiazepines, barbiturates, amphetamines) Opiate purity (unregulated drugs, unfamiliar meds) Using alone (no one to provide care) Using when health-compromised (including respiratory issues) Prior history of overdose (29 times more likely to die of OD) Mental health issues Multiple prescribers

14 What happens in an Overdose Opioids bind to receptors in the brainstem and in high enough levels to shut off the involuntary drive to breath. Opioid overdose causes the individual to literally suffocate (respiratory failure)

15 How to tell if opiate overdose is occurring Person is conscious but high Person is unconscious Pupils small Pupils small Muscles droopy Scratching/itchy Slurred speech Shallow breathing Cold/clammy skin May vomit Muscles- limp Blue lips/nails Breathing shallow, slow, gurgling Skin pale/clammy May vomit

16 Reversing an Overdose: Using naloxone (Narcan) Temporarily reverses effects of opiates Safe to give even if unsure opiates involved Low risk of serious adverse reactions Works exclusively on opiates

17 Legal Implications of Using Naloxone (Narcan) Michigan Public Act 313 (2014) & Good Samaritan Amendment: No criminal liability for administration of naloxone No criminal/civil liability for person revived. Michigan Public Act 462 of 2014: Law enforcement can carry & use naloxone without criminal/civil liability

18 O.D. RESPONSE: Assess first Evidence of overdose nearby? Drug paraphernalia, syringe, pill bottle, etc. Call 911. Rub sternum hard with knuckles to revive. If unresponsive, administer Narcan.

19 O.D. RESPONSE: Use Narcan Spray 1 dose of Narcan in one nostril (insert the spray tip up to your fingers) Spray any leftover in other nostril DO NOT TEST SPRAY IN THE AIR If good respiration resumes, roll patient onto side to recovery position after 1 st dose If breathing doesn t resume in 3-5 minutes, administer second dose in other nostril.

20 O.D. RESPONSE: Use Narcan If breathing doesn t improve, begin rescue breathing until emergency responders arrive. 1. Give slow breath while holding nose every five seconds. 2. Remove mouth after each breath so victim can exhale. 3. Continue rescue breathing as long as victim is not breathing but has pulse.

21 Revival with Narcan will cause Precipitated Withdrawal Dysphoria Insomnia Severe craving Irritability Lacrimation Dilated pupils Rhinorrhea Yawning Elevated blood pressure Mild fever Nausea and vomiting Diarrhea Cramping abdominal pain Joint aching Muscle cramping Hot and cold flashes Goose flesh Tachycardia

22 Questions?

23 OPIOID OVERDOSE FACT SHEET Why do people overdose? In opioid overdose, the drug tells your brain to stop signaling your lungs to breath, potentially causing death by respiratory failure, literally suffocating to death. Are there ways to help prevent an overdose? Use the following checklist and B.E. S.M.A.R.T.!!!! Buddy-system (Let someone know to check on you, don t use alone, leave the door unlocked.) Ease into it (Test all new sources before using the full dose since quality/strength of drugs is unpredictable. Compare pills to online pill databases (like to determine if the pill is actually what a dealer says it is.) Sickness= (Reduce the dose.) Make sure you keep Narcan handy (Let people know you have it and where to find it! Get it out before you use!) Avoid mixing drugs (Use one drug at a time). Opiates alone can be deadly but so can mixing opiates with benzos or alcohol. Reduce after no use (If you have gone longer than 3 days without using due to jail, rehab, etc., cut the amount of use in half.) Take care as you prepare (Use clean works/needles.) What is Narcan (naloxone)? Narcan is a prescription medication that is given to temporarily reverse opioid overdose (only lasts minutes so person may go back into overdose if 911 hasn t been called and Narcan effect wears off). Narcan will NOT get you high no matter how much you take. It s only effect is to reverse an opioid overdose. IN CASE OF AN OVERDOSE - ASSESS, RESPOND, SUPPORT Is the individual really high or overdosing? Signs to look for: slow, shallow breathing, pale, blue, snoring/gurgling; chest pains, difficulty breathing, dizziness, foaming at the mouth, lots of sweat or NO sweat, racing pulse, vomiting, seizures, loss of consciousness. Is the individual responsive? Use sternal rub/knuckles on breastbone: make a fist and place your knuckles against the individual s mid-sternum (plate of bones in the center of the rib cage). Applying firm downward pressure, rub up and down the sternum very hard for at least 30 seconds. If there is no response? Call 911 immediately and administer Narcan to the individual as per the directions on the box! Start RESCUE BREATHING: 1) Pull chin down, look in mouth, scoop out obstruction (finger sweep); 2) Tilt head, lift chin, plug nose, give 2 quick breaths; 3) Continue to give 1 breath every 5 seconds, until breathing resumes or help arrives. I gave one dose of Narcan and there is no change. What now? If after 2-3 minutes following the first Narcan dose there is no change, give a second dose and continue RESCUE BREATHING. The individual is reviving. Now what? Stay with the person. Narcan wears off in minutes and they could go back into an overdose. Stay calm, and firm. They must NOT use more drugs in this phase or they could die. Get the individual to the hospital ASAP. What should I expect if the person wakes up? Following resuscitation, an individual may be confused, irritable, and possibly combative. The individual may go back into OD, so, stay with them and watch closely. The individual could have other health complications too (though this is RARE). Stay calm, try to keep the individual calm, and wait for Emergency Services. NARCAN REFILL OPTIONS: 1. You can return here for a refill kit. 2. If you have Medicaid or Healthy Michigan insurance, you can get a prescription for Narcan and it will be paid for by your insurance! See your primary care doctor about getting a prescription.

24 You don t need to live this way. Help is available. If you or someone you know is struggling with an addiction, please reach out. Jackson & Hillsdale Treatment Providers Henry Ford Allegiance Addiction Recovery Center 2424 W. Washington, Suite 200, Jackson Henry Ford Allegiance Substance Abuse Services 2424 W. Washington, Suite 100, Jackson Family Service & Children's Aid Born Free 300 W. Louis Glick Hwy, Jackson Home of New Vision- Jackson Recovery Resource Center 407 W. Michigan Ave, Jackson Professional Psychological & Psychiatric Services 1200 N. West Ave, Suite 812, Jackson Victory Clinical Services 3300 Lansing Ave, Jackson McCullough, Vargas, Associates, Inc. 110 Reading Ave, Jonesville /7 Crisis & Treatment Referral Line LifeWays Community Mental Health Mid-State Health Network

25 Overdose Response Procedure Signs of an Overdose Limp & unresponsive to stimulation Breathing is slow, shallow, or gurgling Skin is pale and clammy Blue lips and/or nails Rub knuckle on sternum to revive. In Case of Overdose Call 911 report unresponsive & not breathing Use NARCAN Nasal Spray 1. Spray 1 dose in nostril (gently insert) 2. Start rescue breathing. 3. Give 2 nd dose in 3-5 min, if unresponsive. Rescue Breathing Clear airway Pull chin down, look in mouth, scoop out obstruction (finger sweep) Tilt head, lift chin, plug nose, give 2 quick breaths Continue to give 1 breath every 5 seconds, until breathing resumes Evaluate/Support If normal breathing resumes, roll onto side. Revived person will be in withdrawal, physically uncomfortable & may be agitated. Stay with him/her till help arrives. Narcan wears off in minutes, so he/she may slip back into overdose. Use 2 nd dose if still available.