At‐risk patient documentation and naloxone dispersal for a rural statewide EMS “Naloxone Leave Behind” program

Abstract

Abstract Objectives For successful Naloxone Leave Behind (NLB) programs, Emergency Medical Services (EMS) must identify patients at‐risk for opioid overdose. We describe the first year of Vermont's NLB program and report rates of EMS documentation of at‐risk patients with subsequent distribution of NLB kits in the subgroup of those refusing transport to an emergency department (ED). Methods This retrospective cohort review of all EMS encounters over 1 year compared on‐scene EMS documented to retrospective chart reviewidentified at‐risk patients eligible for NLB kit dispersal. EMS was educated to identify at‐risk patients through statewide mandatory training modules. At‐risk patients were identified by electronic chart review using the same training criteria. As per protocol, patients identified as at‐risk by EMS who refuse ED transport are eligible for NLB. NLB‐appropriate patients by retrospective chart review without NLB protocol use documentation by EMS were considered “missed.” Results Of 110,701 EMS encounters, 2507 (2.4%) were at‐risk by chart review. Among these, 793 refused transport to an ED. In this chart‐review at‐risk non‐transported group, EMS documented 407 (51.3%) patients as at‐risk by documenting use of the NLB protocol. Of these 407, EMS provided 141 (34.6%) with NLB kits. Fifteen (3.7%) patients refused kits. There were 386 (48.7%) potentially “missed” opportunities for NLB dispersal. Conclusion EMS documented 51.3% of patients eligible for NLB dispersal, with 34.6% receiving kits. There was no documentation for 48.7% of chart‐review at‐risk patients, suggesting “missed” distribution opportunities. This study highlights the need for improved EMS identification of at‐risk patients, EMS documentation adherence, and NLB kit provision.