Dedicated nursing care pathway improved management of opioid-poisoned patients in the emergency department: A before-after observational study.

Autor: Isoardi K; Clinical Toxicology Unit and Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.; Clinical Toxicology Research Group, The University of Newcastle, Newcastle, New South Wales, Australia.; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia., Learmont B; Clinical Toxicology Unit and Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia., Horan B; Clinical Toxicology Unit and Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia., Isbister G; Clinical Toxicology Research Group, The University of Newcastle, Newcastle, New South Wales, Australia.
Jazyk: angličtina
Zdroj: Emergency medicine Australasia : EMA [Emerg Med Australas] 2023 Feb; Vol. 35 (1), pp. 69-73. Date of Electronic Publication: 2022 Aug 15.
DOI: 10.1111/1742-6723.14056
Abstrakt: Objective: Opioid overdose is increasing and accounts for two-thirds of poisoning deaths. Opioid induced respiratory depression is life-threatening and can be under-recognised even in the hospital setting. We aimed to evaluate the effect of a care pathway on the management of opioid-poisoned patients.
Methods: This is a before-after observational study following the introduction of a nursing care pathway for opioid-poisoned patients presenting to ED. Medical records were retrospectively reviewed pre (6-month period 1 year prior) and post (9-month period following) the introduction of the pathway. The primary outcome was the proportion of documented episodes of respiratory depression (respiratory rate <10 or oxygen saturation <93% on room air) receiving naloxone. Secondary outcomes were time to naloxone, number of documented observations (first 4 h) and length of stay.
Results: There were 111 patients included in the study, 61 pre-intervention and 50 post-intervention (35 followed the pathway). A significantly larger proportion of patients received naloxone for respiratory depression when the pathway was used (134/200 [67%] vs 34/118 [29%], difference 38%, 95% CI 28-48%). The median time to naloxone was similar (pathway 28.5 min vs no pathway 35 min, difference -6.5 min, 95% CI -19 to 12 min). Documentation increased when the pathway was used (12.0 observations/presentation vs 7.5 observations/presentation, difference 4.5 observations/patient, 95% CI 2.1-7.0 observations/patient). Length of stay was similar (pathway 16.7 h vs no pathway 15.3 h, difference 1.4 h, 95% CI -2.4 to 5.9 h).
Conclusions: Following the introduction of a dedicated opioid poisoning nursing care pathway, naloxone delivery and observation documentation increased. A care pathway may improve ED management of opioid poisoning.
(© 2022 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)
Databáze: MEDLINE
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