Development of EPB Change Proposal Project III

Hi,

Please see below assignment. It ties into the other Part I and Part II. I am attaching them to this.

Based on critiqued evidence and synthesis of research, make recommendations forpractice change related to the selected topic• Select appropriate patient outcome goals for the proposed practice change-see LoBiondo-Wood & Haber 9 th ed., Chap. 20, Box 20.5, for examples• Develop an evidence-based practice policy, procedure, protocol or guideline• Determine whether this proposed change is appropriate for use in practice by completingthe “Evaluation of Implementation Potential of an Innovation” and include pertinentelements of this evaluation in your presentation• Describe how you would pilot this practice change – i.e. where, how long, data collectionfor evaluation of pilot, etc.• Identify facilitators and barriers to implementation of this practice change, discussstrategies to address the identified barriers and to promote facilitation of the practicechange• Address legal and ethical issues in translation of this evidence into nursing practice• Apply a model of change (see chapter 3 of White, Dudley-Brown & Terhaar 3 rd ed.) tothe EBP change proposal – you must clearly demonstrate the link between the chosenchange model and the components of your proposal• Part III will be posted in Moodle as a voiceover PowerPoint presentation• Submitted PowerPoint slides must include your talking points in the “Notes section”under each slide• There should be approximately 20 slides for Part III• Include the PICO question at beginning of your presentation Project Part I
Shana Spratt
College of Nursing, Elms
November 6, 2023
Introduction
• Opioid overdose is a common problem within the healthcare setting.
• This challenge affects patients and may lead to addiction and overdependence (Scholl et al.,
2019).
• Practitioners at the rehabilitation center like inpatient detox are responsible for health promotion.
• Some ways to achieve the expected goals is by:
• Implementing educational interventions.
• Adopting preventive measures.
• This project addresses the need and impacts of adopting Naloxone Distribution overdose
education program in opioid overdose detection and reversal.
The topic
• This project has selected the topic concerning the adoption of the Naloxone
Distribution overdose education program guidelines.
• The rationale for selecting this project is:
• The need to prevent opioid overdose in the tertiary setting.
• Develop a mechanism for understanding and detecting opioid overdose.
• The program will focus on reversing the impacts of the challenge by
promoting wellness and general patient wellbeing (Scholl et al., 2019).
The problem statement
• The topic in the context reflects on the prevalence of opioid and drug
overdose incidents.
• In the United States, drug overdose mortality has increased:
• 3,442 to 17,029 between 1999 and 2017 (Scholl et al., 2019).
• Opioid overdose mortality:
• Increased to 75.4% in 2021 (CDC, 2023).
• Preventing drug overdose is critical for health promotion.
Problem-focused and knowledge-focused
triggers
• Opioid overdose is a common challenge that can be understood from multiple
dimensions.
• Problem focused triggers
• Knowledge focused triggers
• Many patients are prescribed opioids due to underlying conditions.
• Knowledge gaps may accelerate the condition.
• The proposed initiative should priorities knowledge delivery and practice expertise
to mitigate the associated challenges (Scholl et al., 2019).
Hypothetical team
•
This project will benefit from a multidimensional and disciplinary team comprising:
•
Nurse practitioners
•
•
Certified nurse assistants
•
•
2 members
Nurse educators
•
•
3 members
Nurse anesthetists
•
•
2 members
5 members
•
To educate other practitioners, patients and family members.
•
To assist in developing community- based programs.
Clinical nurse specialists
•
2 members.
•
Family members
•
Patients
•
Community nurses
•
5 members:
•
To coordinate the community -based interventions in health promotion (Razaghizad et al., 2021).
Key stakeholders
•
This project will be influenced by the respective stakeholders.
•
The stakeholders likely to support the project are:
•
Community based nurses
•
Family members
•
Patients
•
The initiative is concerned about health promotion.
•
It will reduce risks of overdose.
•
It will help patients suffering from an overdose.
•
Nurse educators
•
The potential resistance may come from:
•
Nurse assistants
•
Nurse anesthetists
•
Nurse practitioners
•
The rationale for this resistance is disruption of their normal working patterns (Razaghizad et al., 2021).
Impacts of stakeholders on project
implementation
• The supporting stakeholders will include:
• Community health nurses
• Family members
• Patients
• Nurse educators
• These stakeholders will support the initiative because of the capacity:
• To identify and detect overdose incidents.
• To establish a preventive measure against overdose.
• To facilitate reversal (Wilson et al., 2020).
Evidence based practice question
•
•
•
•
•
•
•
•
The problem above can be formulated using an evidence-based framework.
This statement can be presented as follows:
P: Practitioners, patients and family members (Razaghizad et al., 2021).
I: Developing guidelines for a Naloxone Distribution overdose education program
C: No guidelines
O: Reducing overdose rates
PICO Question:
Among practitioners, family members and patients, what is the effect of developing Naloxone Distribution
education program guidelines in detecting, reversing and preventing opioid overdose compared to no
interventions?
Conclusion
•
•
•
•
This project proposes the development of guidelines for opioid detection, reversal and prevention.
In this intervention, the proposed guidelines will involve:
•
Nurses within the tertiary setting.
•
Family members.
•
Patients.
It is expected that the initiative:
•
Will help practitioners to identify at risk patients.
•
Understand signs and symptoms.
•
Promote early detection.
•
Reverse existing overdose incidents.
Empower patients and family members with:
•
Knowledge to identify knowledge gaps and triggers.
References
• CDC. (2023). Drug Overdose Deaths. CDC.
https://www.cdc.gov/drugoverdose/deaths/index.html#:~:text=Opioids%E2%80%94mainly%
20synthetic%20opioids%20(other,of%20all%20drug%20overdose%20deaths).
• Scholl, L., Seth, P., Kariisa, M., Wilson, N., & Baldwin, G. (2019). Drug and opioid-involved
overdose deaths—United States, 2013–2017. Morbidity and mortality weekly report, 67(51-52), 1419.
• Wilson, N., Kariisa, M., Seth, P., Smith IV, H., & Davis, N. L. (2020). Drug and opioid-involved
overdose deaths—United States, 2017–2018. Morbidity and Mortality Weekly Report, 69(11), 290.
• Razaghizad, A., Windle, S. B., Filion, K. B., Gore, G., Kudrina, I., Paraskevopoulos, E., … &
Eisenberg, M. J. (2021). The effect of overdose education and naloxone distribution: an umbrella
review of systematic reviews. American journal of public health, 111(8), e1-e12.
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Literature Review: Naloxone Distribution Education Programs
Shana Spratt
College of Nursing, Elms College
November 13, 2023
2
Literature Review: Naloxone Distribution Education Programs
Overview
Opioid overdose takes place when an individual consumes a quantity of these drugs that
exceeds the ability of the body to metabolize and process them. Such an occurrence can result in
various symptoms, such as respiratory problems, loss of consciousness, or even death (Haegerich
et al., 2019). Haegerich et al. (2019) suggest that identifying strategies that can aid in preventing
opioid overdose and influence patients and provider actions is vital. This research emphasizes
that establishing approaches necessary for treatment processes is critical in preventing opioid
abuse and overdose. Opioid overdose in tertiary settings calls for effective approaches and
specialized care. The naloxone distribution overdose education program is one effort to address
and respond to opioid overdose. According to Razaghizad et al. (2021), the increase in overdose
education and naloxone distribution programs has been proposed as a potential response to the
opioid crisis. Razaghizad and associates researched to explore the effects and viability of these
programs and identify areas for optimization. This study established that the programs lead to
long-term knowledge enhancement concerning opioid overdose. The research further found that
overdose education and naloxone distribution programs improved patients’ attitudes concerning
naloxone and reduced opioid-associated mortality.
These findings resonate with insights by Jakubowski et al. (2019). This study suggests
that overdose education and naloxone distribution to inpatient medical environments can
potentially reach people at high risk, especially those who do not have access to decreased
services and have obtained training. Findings by Jakubowski and associates indicated that
incorporating such a distribution is attainable and has the capacity to reach the target patients.
Similarly, Rudisill et al. (2021) agree that these programs reduce opioid-associated fatalities.
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According to Lambdin et al. (2020), education interventions can prevent certain infections such
as the human immunodeficiency virus. Similarly, the research provides that such knowledge
obtained through such initiatives can lead to a reduction in opioid overdose deaths. These
programs train caregivers in tertiary settings on how to respond during overdose events and offer
guidelines on drug delivery.
Facilitators of Implementation
Several facilitators have been associated with the effective implementation of these programs.
For example, Rudisill et al. (2021) carried out structured interviews among internal and external
stakeholders in a healthcare facility. The research found that the primary facilitators include
combined efforts, ease of contributing to the programs, need for naloxone and individual
protection from an overdose. Likewise, Sellen et al. (2023) identified factors that facilitated the
effective implementation of naloxone distribution education programs. This analysis noted that
these initiatives served a fundamental role in equipping and training people on ways of
responding to the occurrence of an overdose. Sellen and associates established that identifying
overdose, amount of naloxone, effects of stigma, the legal risk associated with responding to
incidents, contributions as conventional first aid, and family as possible facilitators of these
interventions. According to Jawa et al. 2020, to combat opioid overdose in healthcare settings,
incorporating flexible, brief, and effective training can be essential. The study suggests that such
training incorporates practical interventions for health stakeholders at various levels of
education. This research argues that the integration of this education program can equip future
healthcare professionals with essential knowledge for approaching opioid overdose.
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Challenges and Barriers to Implementation
Implementing naloxone distribution education programs often faces various challenges
and barriers that hinder their effectiveness. According to Worthy (2022), one practice problem
includes the inexistence of patient or family education documents that healthcare professionals
can utilize as a guide to inform individuals about opioid risk. According to this study, the lack of
such a document makes it challenging for healthcare providers to educate patients on the
appropriate management of naloxone to avoid opioid overdose, especially in the outpatient
environment. On the other hand, Rudisill et al. (2021) outlined various factors, including
bureaucracy, policy, and processes of an organization as primary barriers. The research further
found that stigma, logistic concerns, reporting issues, and lack of communication, especially
post-distribution, after the effectiveness of these programs. Similar to the research by Rudisill et
al. (2021), Salvador et al. (2020) found that barriers to successfully implementing these
education programs cut across patient, agency, and policy levels. Salvador and associates
established that persistent barriers include receptiveness by the patient, costs related to naloxone,
staff time, and prohibitive regulations. Thakur et al. (2020) is another study that attempted to
identify barriers to these programs. The research proposed that pharmacists are properly placed
to recognize patients at a heightened risk of overdose, distribute naloxone, and guide individuals
on the appropriate usage. However, it established that these professionals are often underutilized
and lack programs that support their roles. Thakur and associates identified that this lack of
training on the part of pharmacists limits their ability to educate individuals, especially those at
risk of overdose.
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Future Considerations
According to Bennett & Elliott (2021), in recent years, naloxone has become a vital
lifesaving overdose antidote. However, this study highlights access and training on naloxone
distribution remains limited in many regions. The research proposes tapping into technology to
increase accessibility and provide education about naloxone distribution. Similarly, Jakubowski
et al. (2019) offer that naloxone distribution programs have traditionally been offered through
harm reduction facilities. Hence, the study suggests the need for finding the optimal way of
deploying such services. These insights are further echoed by Razaghizad et al. (2021). The
review states that these programs are effective in minimizing opioid-associated mortality.
However, the research provides that further high-quality exploration is essential to optimize the
effectiveness of these programs.
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References
Bennett, A. S., & Elliott, L. (2021). Naloxone’s role in the national opioid crisis—past struggles,
current efforts, and future opportunities. Translational Research, 234, 43-57.
Haegerich, T. M., Jones, C. M., Cote, P. O., Robinson, A., & Ross, L. (2019). Evidence for state,
community and systems-level prevention strategies to address the opioid crisis. Drug and
alcohol dependence, 204, 107563.
Jakubowski, A., Pappas, A., Isaacsohn, L., Castillo, F., Masyukova, M., Silvera, R., … &
Bachhuber, M. A. (2019). Development and evaluation of a pilot overdose education and
naloxone distribution program for hospitalized general medical patients. Substance
abuse, 40(1), 61-65.
Jawa, R., Luu, T., Bachman, M., & Demers, L. (2020). Rapid naloxone administration workshop
for health care providers at an academic medical center. MedEdPORTAL, 16, 10892.
Lambdin, B. H., Bluthenthal, R. N., Wenger, L. D., Wheeler, E., Garner, B., Lakosky, P., &
Kral, A. H. (2020). Overdose education and naloxone distribution within syringe service
programs—United States, 2019. Morbidity and Mortality Weekly Report, 69(33), 1117.
Razaghizad, A., Windle, S. B., Filion, K. B., Gore, G., Kudrina, I., Paraskevopoulos, E., … &
Eisenberg, M. J. (2021). The effect of overdose education and naloxone distribution: an
umbrella review of systematic reviews. American journal of public health, 111(8), e1e12.
Rudisill, T. M., Ashraf, A. J., Linn, H. I., Sayres, S., Jeffries, J. E., & Gurka, K. K. (2021).
Facilitators, barriers and lessons learnt from the first state-wide naloxone distribution
conducted in West Virginia. Injury prevention, 27(4), 369-374.
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Salvador, J. G., Sussman, A. L., Takeda, M. Y., Katzman, W. G., Moya Balasch, M., &
Katzman, J. G. (2020). Barriers to and recommendations for take-home naloxone
distribution: perspectives from opioid treatment programs in New Mexico. Harm
Reduction Journal, 17(1), 1-8.
Sellen, K., Markowitz, B., Parsons, J. A., Leece, P., Handford, C., Goso, N., … & SOONER
Investigators. (2023). Considerations for the design of overdose education and naloxone
distribution interventions: results of a multi-stakeholder workshop. BMC public health,
23(1), 888.
Thakur, T., Frey, M., & Chewning, B. (2020). Pharmacist roles, training, and perceived barriers
in naloxone dispensing: a systematic review. Journal of the American Pharmacists
Association, 60(1), 178-194.
Worthy, T. Y. S. A. (2022). Opioid Naloxone Education Clinical Practice Guideline.
Level of Evidence
Author (s) Name
Title of the Article
Level of Evidence
Bennett & Elliott (2021)
Naloxone’s role in the national
Level VI
opioid crisis—past struggles,
current efforts, and future
opportunities
Haegerich, Jones, Cote,
Evidence for state, community
Robinson & Ross (2019)
and systems-level prevention
strategies to address the opioid
crisis
Level 1
8
Jakubowski, Pappas, Isaacsohn,
Development and evaluation of
Castillo, Masyukova, Silvera &
a pilot overdose education and
Bachhuber, (2019).
naloxone distribution program
Level IV
for hospitalized general medical
patients
Jawa, Luu, Bachman & Demers,
Rapid naloxone administration
(2020).
workshop for health care
Level VI
providers at an academic
medical center
Lambdin, Bluthenthal, Wenger,
Overdose education and
Wheeler, Garner, Lakosky &
naloxone distribution within
Kral, (2020).
syringe service programs—
Level IV
United States, 2019
Razaghizad, Windle, Filion,
The effect of overdose
Gore, Kudrina,
education and naloxone
Paraskevopoulos, & Eisenberg,
distribution: an umbrella review
(2021)
of systematic reviews
Rudisill, Ashraf, Linn, Sayres,
Facilitators, barriers and lessons
Jeffries & Gurka, (2021).
learnt from the first state-wide
naloxone distribution
conducted in West Virginia.
Level I
Level VI
9
Salvador, Sussman, Takeda,
Barriers to and
Katzman, Moya Balasch &
recommendations for take-
Katzman, (2020).
home naloxone distribution:
Level IV
perspectives from opioid
treatment programs in New
Mexico.
Sellen, Markowitz, Parsons,
Considerations for the design of
Leece, Handford, Goso &
overdose education and
SOONER Investigators. (2023)
naloxone distribution
Level VI
interventions: results of a multistakeholder workshop
Thakur, Frey & Chewning,
Pharmacist roles, training, and
(2020)
perceived barriers in naloxone
Level I
dispensing: a systematic review
Worthy (2022)
Opioid Naloxone Education
Clinical Practice Guideline
Level VI