Part IV: Evaluation & Dissemination

Part IV: Evaluation & Dissemination • Reiterate patient outcome goals identified in Part III and discuss several effective ways toevaluate these goals• Identify important process components that should be evaluated for this project – i.e. howthe practice change is being implemented, for example: staff behaviors that are necessarywhen implementing this practice change-identify pertinent process measures and how they will be evaluated-see LoBiondo-Wood & Haber 10 th ed., Chap. 20, Box 20.5, for examples• Include a timeline for the evaluation process• Discuss various methods for effectively disseminating the findings of this project to itsstakeholders• Part IV will be posted in Moodle as a voiceover PowerPoint presentation• There should be approximately 10 slides for Part IV• Be sure to include your talking points in the notes section of each slide• Include the PICO question at beginning of your presentation

I will include the first 3 parts of the project.

1
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.
3
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.
4
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.
6
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.
7
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
Development of EPB
Change Proposal Project III
Shana Spratt
College of Nursing, Elms
December 4, 2023
Objectives
• This project will provide information about the proposed innovation about the distribution
•
•
•
•
•
•
•
of Naloxone Education Programs.
In achieving this goal, the project will:
Select appropriate patient outcome goals.
Assess appropriateness for practice.
Piloting the study.
Identifying barriers and facilitators.
Legal and ethical concerns.
Change modeling.
Introduction
• Patient care delivery is an essential aspect in the health sector.
• It involves diverse practitioners and stakeholders.
• This project proposes a naloxone distribution program.
• The program will target:
• Practitioners
• Patients
• Family members
• General community.
• It will raise awareness on opioid overdose by recommending best practices (CDC, 2023).
The problem and need for change
• The United States has recorded an increasing trend in opioid overdose (CDC, 2023).
• This problem is common among people from diverse communities.
• It is essential to improve community wellness through:
• An educational program (Razaghizad et al., 2021).
• Awareness creation in clinical setting.
• The project proposes guidelines for the naloxone distribution educational
intervention.
PICO Question
• Population: Health practitioners, patients, community and family members.
• Intervention: Guidelines for the naloxone distribution educational program.
• Comparison: No intervention.
• Outcome: Opioid overdose cases reduction (CDC, 2023).
Patient outcome goals
• The core goals informing the implementation of the proposed initiatives
relate to:
• To ensure a 50% increase in the distribution of the kits to the target
populations.
• Achieve a 10% increase in awareness about the best guidelines for
distributing the programs among practitioners, family members and patients.
• Guarantee a 50% reduction of opioid mortality rates in 24 months
(LoBiondo-Wood & Haber, 2017).
Policy recommendation
• Creating a high level policy will benefit clinical settings and the target
audiences (CDC, 2023).
• This section proposes:
• A policy that must contain:
• Implementation guidelines
• The involved teams including their roles and responsibilities.
• Expected goals.
Cont.
• Other elements to include in the proposed policy may include:
• Evaluation plan.
• Schedule and timing.
• Target audience.
• Milestones and deliverables.
• These elements will provide a reference framework for implementing the
policy at the clinical setting (Razaghizad et al., 2021).
Alignment with application to practice
• When implementing an innovation, it is essential to evaluate its clinical
implications (Razaghizad et al., 2021).
• Numerous metrics can be used:
• Impacts on target audiences.
• Demand within the respective setting.
• Feasibility.
• Timing according to the prevailing trends.
Impacts on practice
• The proposed intervention is positively aligned with clinical practice because:
• It is timely
• It offers recommended best practices to minimize dangers of opioid
overdose (CDC, 2023).
• Reduce complications associated with opioid overdose by:
• Empowering patients with awareness to detect such incidents.
• Educate practitioners on best practices to promote patient health.
Piloting the study
• When implementing the program, it is essential to observe its implications.
• Piloting is critical for initial assessment and validation.
• The program will be implemented in a common local area.
• At least five facilities will be selected.
• Convenience sampling will be used.
• The most relevant departments will be selected.
Cont.
• Data about the pilot study will be collected from diverse settings.
• Clinical emergency departments.
• Rehabilitation departments.
• This information will be collected over 12 months.
• Weekly and monthly reports will be generated.
• Variables to be used may include:
• Awareness levels
• Opioid overdose complications and mortality trends (Scholl et al., 2019).
Facilitators and barriers
• The implementation of the program will be affected by various factors.
• The core supporting attributes are:
• Maximum awareness of the problem.
• Collaboration between multidisciplinary teams.
• Support from the relevant stakeholders (Perregrini, 2019).
Cont.
• Implementing the proposed interventions will be affected by various variables:
• Resistance to change from practitioners (Perregrini, 2019).
• Disruptions of the current working and organizational culture.
• Resources limitations:
• Time
• Finances
• Human capital.
Ethical issues in translation
• The government has set various regulations influencing the project.
• These frameworks and requirements may include:
• Training standards for nursing teams (von Vogelsang et al., 2020).
• Scope of practice.
• Administration roles.
Cont.
• The proposed research is governed by various ethical guidelines.
• The core requirements that must be observed relate to:
• Patient privacy and confidentiality in data collection.
• Harm reduction in intervention adoption.
• Consent before enrollment (von Vogelsang et al., 2020).
• Patient safety guarantee.
Change model application
• Change management is critical in the proposed intervention.
• Numerous models may be used.
• This project selected the Kotter`s model of change (White et al., 2019).
• It was adopted because:
• It is comprehensive.
• Offers a stage-wise implementation framework.
• Easy to translate theory into practice.
Cont.
•
•
•
•
•
•
•
•
•
•
The proposed changes will be adopted through an eight-step framework.
The core stages will involve:
Urgency creation
Forming alliances
Establishing a shared vision.
Communicating the common team vision.
Eliminating challenges like resistance.
Developing short term milestones and deliverables.
Building on the new changes (White et al., 2019).
Integrating recommendations into a new corporate culture.
Conclusion
• This project has addressed the role of integrating a policy to guide Naloxone distribution
•
•
•
•
•
•
awareness.
The recommended policy may promote awareness necessary for achieving sustainable health
outcomes.
It is essential to select the ideal team to work on the project.
Sufficient resources and human capital must be allocated.
Adopting the program will promote security by:
Reducing risks of overdose.
Ensuring awareness.
References
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•
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White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2019). Translation of evidence into nursing and healthcare. Springer Publishing Company.
•
•
LoBiondo-Wood, G., & Haber, J. (2002). Nursing research: Methods and critical appraisal for evidence-based practice.
•
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.
•
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).
Perregrini, M. (2019). Mitigating resistance to change in the workplace. Creative Nursing, 25(2), 154-156.
von Vogelsang, A. C., Swenne, C. L., Gustafsson, B. Å., & Falk Brynhildsen, K. (2020). Operating theatre nurse specialist competence to
ensure patient safety in the operating theatre: A discursive paper. Nursing open, 7(2), 495-502.
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.
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
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2 members.
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Family members
•
Patients
•
Community nurses
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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:
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Community based nurses
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Family members
•
Patients
•
The initiative is concerned about health promotion.
•
It will reduce risks of overdose.
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It will help patients suffering from an overdose.
•
Nurse educators
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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
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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
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•
•
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This project proposes the development of guidelines for opioid detection, reversal and prevention.
In this intervention, the proposed guidelines will involve:
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Nurses within the tertiary setting.
•
Family members.
•
Patients.
It is expected that the initiative:
•
Will help practitioners to identify at risk patients.
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Understand signs and symptoms.
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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.