Increasing take-home naloxone kit distribution to patients with substance use disorder before hospital discharge: a quality improvement project

Abstract

The ongoing drug toxicity crisis is a growing public health challenge in many countries across the world. Despite the WHO's recommendation of take-home naloxone (THN) kits as a cost-effective harm reduction strategy to prevent drug toxicity deaths, the Addiction Medicine Consult Team (AMCT) at Burnaby Hospital found that only 51% of their eligible patients were receiving a kit before discharge. In response, the AMCT created a quality improvement (QI) team with the aim of increasing their THN kit distribution rate on two hospital wards from 51% to over 80% within 10 months.Change ideas were implemented with the aim of targeting various components of the THN kit distribution process. Changes included adjusting THN kit inventory on wards, hosting education sessions for nurses, creating just-in-time training using nursing station whiteboards, streamlining the documentation process for nurses and standardising the ordering process for providers. The QI team collaborated with hospital interest holders including senior executives, nursing and pharmacy groups to facilitate change ideas. The project culminated with 4 months of sustained THN kit provision above 80%.The QI team is currently in talks with hospital operations to ensure that an effective documentation system will be integrated into the new electronic medical record system when the hospital transitions away from paper charting in 2025.

Keywords: Harm Reduction; Healthcare quality improvement; Hospital medicine; PDSA; Quality improvement.

Figure 1. Driver diagram. AMCT, Addiction Medicine Consult Team; SUD, substance use disorder; THN, take-home naloxone; ER, emergency room

Figure 2. Improving THN kit provision rates in AMCT patients at Burnaby Hospital. AMCT, Addiction Medicine Consult Team; THN, take-home naloxone.