Narcan drips

Wow. I've worked PICU for nearly 17 years and have only ever seen one patient on a Narcan infusion. And that was a toddler who'd ingested a bunch of Grandma's MS Contin.

The use of Narcan as either prophylaxis or treatment of opioid-induced pruritus hasn't been studied enough for good data on its efficacy or apporpirate dosing. It hasn't ever been on our radar here. The few studies that have been carried out have identified limitations in its use, due to difficulty in finding the balance between adequate analgesia and acceptable itching. I think in your situation there needs to be a concerted education effort for the staff on your inpatient units so they understand the rationale for the infusion, which isn't to reverse a potentially life-threatening respiratory depression from opioid use, but to reduce the itching. There also needs to be a protocol with standard orders developed for the ward staff so they aren't overly stressed by having a patient on the infusion similar to the one your hospital must have for continuous morphine infusions on the wards.