Study to evaluate opioid poisoning care pathway
A before and after study is assessing the implementation of a nursing care pathway for opioid patients in the Emergency Department which aims to optimise patient management and improve outcomes.
Emergency physician and clinical toxicologist Dr Katherine Isoardi, Director of the Princess Alexandra Hospital Clinical Toxicology Unit and Medical Director of Queensland Poisons Information Centre, is leading the project.
Background data suggests presentations of patients with opioid poisoning to the Princess Alexandra Hospital has steadily increased by 32% over a five-year period, from 404 patients in 2015 to 533 patients in 2019. There were 14 deaths attributable to opioid poisoning in this cohort over the period – which represent more than half (54%) of the total poisoning deaths.
Last year, 348 people presented to the Clinical Toxicology Unit with opioid poisoning. Of these 110 received naloxone for severe poisoning.
“I’m passionate about the management of patients with opioid poisoning,” Dr Isoardi said. “I see them as a group that is neglected as a whole.”
Dr Isoardi said patients who present with opioid poisoning often don’t get sympathy in the health system, and don’t necessarily get the observations they need which can essentially be lifesaving.
She said the pathway concept, which was implemented in the department late last year, had “been on my mind for a little while” with evidence suggesting that if patients “have fantastic nursing care they do really well”.
The emergency opioid pathway is for patients managed in a resuscitation bay following suspected recreational exposure or deliberate self-poisoning of opioids. The care pathway designates set observation times as well as a clinical trigger for the administration of naloxone, the antidote to opioid poisoning.
“I can’t have enough praise for our nurses. I think they like the independence it affords them. They can manage a problem within their scope, and it’s given them a new skill.”
In addition, Dr Isoardi said it also frees up resources, “in a way”.
“It frees up resources by treating issues early,” she said. “In my opinion it is less likely people will deteriorate … when managed early and up front.”
The project Assessing the implementation of a nursing care pathway for opioid poisoned patients in the ED; a before and after study received support from the 2021 PA Research Foundation as recipient of the Emergency Medicine Small Grant Project.
“I really couldn’t be more grateful,” Dr Isoardi said. “It is making it easier to evaluate this and potentially roll it out. This area doesn’t attract a lot of grants and funding.”
It is expected the study will take a year to complete. Preliminary data suggests the pathway is working however more data still needs to be collected.