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Narcan

Posted

I currently work at a jail and we are trying to advocate getting narcan for our intake nurses. My administrator told us that we could not do that because patients who receive narcan are supposed to be on continuous cardiac monitoring afterwards. I would assume that if I had to narcan someone in a jail then EMS would be called as well. Has anyone heard of this?

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 11 years experience.

Look at Narcan use by police in ocean county NJ. Let me see if I can find you an article. EMS is activated once Narcan protocol is initiated.

That is what we all thought. I think they just are trying to save money.

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 11 years experience.

Here you go, ocean county is using nasal spray and even offering it to families with training for free otherwise the kits cost $25.

http://www.nj.com/ocean/index.ssf/2014/07/officials_to_give_out_100_free_narcan_kits_in_ocean_county.html

http://www.nj.gov/governor/news/news/552014/approved/20140402a.html

One young female was saved from a Fentanyl OD on May 16 only to be found DOA of fentanyl OD on May 19. But otherwise quite a few lives have been saved with the current OD epidemic.

That's a bunch of crap. We used to give narcan on a semi-regular basis. We had no monitoring capabilities on my ward and we didn't transfer patients post-administration.

amoLucia

Specializes in LTC.

Look at Narcan use by police in ocean county NJ. Let me see if I can find you an article. EMS is activated once Narcan protocol is initiated.
Narcan was also just used by police in Riverton or Riverside (?) in Burlington County. But I believe it was used in the field. Didn't read the article.

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 11 years experience.

That's a bunch of crap. We used to give narcan on a semi-regular basis. We had no monitoring capabilities on my ward and we didn't transfer patients post-administration.

In my examples 911/EMS is activated by police per policy. Just like EMS is activated at a MVA if someone states they have an injury even if not EMS worthy.

In the family protocol, EMS is activated if needed.

They are adding nasal narcan the basic EMT protocol, EMT-B can at best to basic VS and maybe a spot pulse oximetry check. EMT-Bs do not have the training or equipment for 3, 5, or 12 lead assessment or monitoring. Clearly benefit outweighs the risk.

The cost is low. The need for extensive monitoring is debatable. If the individual does not respond to narcan (took something other than an opiate) then EMS & transport is needed anyway. The risk is relatively low. Benefit is high. Perhaps show the policy from NJ I linked above. Even COs can be trained to admin if necessary just like field police officers. Their logic is bunk.

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 11 years experience.

Narcan was also just used by police in Riverton or Riverside (?) in Burlington County. But I believe it was used in the field. Didn't read the article.

There were at least a dozen uses by police in Ocean County this month alone. One week in May there were over a dozen uses by police most successful. It saves lives.

Oh'Ello, BSN, RN

Specializes in Heme Onc.

I've never heard of that, I've heard of strict 1 to 1 monitoring after narcan administration, because depending on how much opiate the patient has had... once the narcan half lives and falls off the receptors, the patient can basically just OD again on whats left in their blood stream. I've given narcan a few times in clinical, and have definitely seen it given at work (In a psych hospital) MANY times... and no one was put on cardiac monitoring save for those who were already on it.

**I guess the naloxone insert recommends cardiac monitoring though...after having done a quick google search.**

Edited by Oh'Ello
**but a quick google search reveals**

june2009

Specializes in long-term-care, LTAC, PCU. Has 13 years experience.

That makes no sense. Let people die of drug ODd because you don't have the ability to monitor them after the narcan is given? Sounds like administration is trying to save some $$$. Narcan is relatively cheap though...

BrnEyedGirl, BSN, MSN, RN, APRN

Specializes in Cardiac, ER. Has 18 years experience.

Per ESI, Narcan makes our pt's Level 1's,....it is considered a "life saving drug" and pt's must be transported via EMS once given,....often after the Narcan wears off, and the pt remains A/O they are allowed to leave AMA but they must be transported.

annie.rn

Has 21 years experience.

We give it frequently on our Med/Surge unit and the protocol does not require cardiac monitoring after administration. We throw them on continuous pulse ox for a while just to be safe but that's not required per protocol. I think they are pulling a fast one.

ChristineN, BSN, RN

Specializes in Pediatric/Adolescent, Med-Surg.

We give it frequently on our Med/Surge unit and the protocol does not require cardiac monitoring after administration. We throw them on continuous pulse ox for a while just to be safe but that's not required per protocol. I think they are pulling a fast one.

Why are you giving it "frequently" in med-surg? I work ER and I have maybe given it 2-3 times.

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 10 years experience.

We give it frequently on our Med/Surge unit and the protocol does not require cardiac monitoring after administration. We throw them on continuous pulse ox for a while just to be safe but that's not required per protocol. I think they are pulling a fast one.

Who's writing the narc scripts on your unit if you have to use it frequently??

Per UTD:

"Monitoring Parameters

Respiratory rate, heart rate, blood pressure, temperature, level of consciousness, ABGs or pulse oximetry"

annie.rn

Has 21 years experience.

Who's writing the narc scripts on your unit if you have to use it frequently??

Per UTD:

"Monitoring Parameters

Respiratory rate, heart rate, blood pressure, temperature, level of consciousness, ABGs or pulse oximetry"

I apologize. I was too flippant in my response. "Frequently" was a bit of an exaggeration. I work nights at a non-teaching hospital and from what I have observed, the nurses seem reluctant to call the docs for things at night so they get a bit heavy handed w/ the narcs and prns at times.

Also, we have a few doctors that prescribe very heavy handedly, IMO.

Example: Post-op laminectomy: Dilaudid PCA (0.2mg dose /10min. lockout/4.0mg 4 hr. limit), Norco 10/325mg 2 tabs. q 4 hr. prn, Serax 15-30 mg q 4 hr. prn (which they want given in tandem w/ the Norco), Flexeril 10mg q8 prn, Nuerontin 600mg BID, Restoril 30mg @ hs prn.

These patients are frequently given all of these prn's every time they can. Most are not narcotic/benzo naive and can handle it but I have come on shift to find a few of them gorked out and hallucinating. BUT, better keep their pain score w/ in goal lest we get a bad survey!

You are right, though, about the monitoring and I stand corrected. And slightly embarrassed. I really was thinking about cardiac monitoring only. The other assessments, to me, were a given and don't require any extra equipment (w/ the exception of ABG capability).

BTW, per protocol, a rapid response is called any time Narcan is given so the patients are monitored closely throughout.