As a clinical pharmacist in the emergency department (ED) at Hamilton General Hospital (HGH), Harsit Patel regularly sees patients who have experienced a drug overdose.
“We’ve had an increased use of opioids in the community, misuse of it,” he says, noting that a patient just two beds over required Naloxone earlier that day.
He knew Naloxone kits – portable take home pouches containing the opioid overdose antidote, Naloxone, and instructions for administering it – were available at local public health offices and some retail pharmacies. But barriers like location and hours were limiting the number of people taking advantage of the kits.
“They asked for it by name to us, but we weren’t able to provide it.”
“Unfortunately, many people were not going to places where Naloxone kits are available to pick up.”
Harsit felt the ED was the ideal place to distribute Naloxone kits. He had even heard that directly from patients.
“There were some overdose patients that we talked to who wanted the kit,” he recalls. “They asked for it by name to us, but we weren’t able to provide it. We were able to tell them they could go to their pharmacy, they could go to public health, but there were some restrictions around that. Those places aren’t open all the time. The best time to give them something is right when it happens, before they leave.”
Bringing Naloxone Kits closer to Hamilton patients
Harsit knew what he wanted to do, but putting the idea into action was daunting. Thankfully, the ED at HGH had recently adopted Hamilton Health Sciences’ CQI management system. CQI, which stands for Continuous Quality Improvement, is based on lean management principles and provides a framework for frontline staff to tackle problems and take advantage of opportunities they encounter on their units. It also bridges the gap between frontline staff and management to find efficient and lasting solutions that bring more value to patients.
“We mentioned the idea of bringing Naloxone kits into the ED at one of our morning CQI huddles,” says Harsit. “Luckily, the director of our program and also the president of the hospital were on hand. And that got them thinking that this kind of seems like a thing the General, knowing our population and the community that we’re in would benefit from.”
With a push from CQI, Harsit had support from an educator and social worker to create a rollout program for the Naloxone kits. They also developed customized educational materials to include in them.
“Trying to come up with this solution without putting it on the CQI board, I really didn’t go very far in about six months,” he says. “But once it was on the board I think the timelines went to, within a month, it was at this site, we developed the education and then within three months it was at every emergency department at Hamilton Health Sciences.”
Harsit says the availability of the kits in the emergency department eliminates a barrier for patients. By giving them the kits right after a visit to the ED for an overdose, staff are also able to provide teaching and share resources are available in the community for support.
What’s in Naloxone kits?
When someone overdoses, their breathing slows down or stops completely. Signs of an overdose include not being able to stay awake, walk, talk, or breathe. The person may have a limp body, make gurgling sounds, have pale or blue skin, tiny pupils, or be vomiting. If you suspect someone has overdosed, call 911 immediately.
The take-home Naloxone kits include enough medicine to reverse opioid overdose for 10-15 minutes, allowing patients enough time to access emergency services. There are two types of kits: an injectable naloxone kit and a nasal spray naloxone kit and each come with their own supplies. Each kit also contains education material and contact information that could help prevent future overdoses.
We know many patients do not intentionally overdose and may be unaware their supply of drug contains opioids.
Where can you get Naloxone kits in Hamilton?
The Ontario government website has an interactive map to show where you can find free Naloxone kits in the community and get training on how to use them. Some pharmacies, community-based organizations, and correctional facilities carry Naloxone kits.