Dedicated nursing care pathway improved management of opioid-poisoned patients in the emergency department: A before-after observational study

Objective Opioid overdose is increasing and accounts for two-thirds of poisoning deaths. Opioid induced respiratory depression is life-threatening and can be under-recognised even in the hospital setting. We aimed to evaluate the effect of a care pathway on the management of opioid-poisoned patients. Methods This is a before-after observational study following the introduction of a nursing care pathway for opioid-poisoned patients presenting to ED. Medical records were retrospectively reviewed pre (6-month period 1 year prior) and post (9-month period following) the introduction of the pathway. The primary outcome was the proportion of documented episodes of respiratory depression (respiratory rate <10 or oxygen saturation <93% on room air) receiving naloxone. Secondary outcomes were time to naloxone, number of documented observations (first 4 h) and length of stay. Results There were 111 patients included in the study, 61 pre-intervention and 50 post-intervention (35 followed the pathway). A significantly larger proportion of patients received naloxone for respiratory depression when the pathway was used (134/200 [67%] vs 34/118 [29%], difference 38%, 95% CI 28-48%). The median time to naloxone was similar (pathway 28.5 min vs no pathway 35 min, difference -6.5 min, 95% CI -19 to 12 min). Documentation increased when the pathway was used (12.0 observations/presentation vs 7.5 observations/presentation, difference 4.5 observations/patient, 95% CI 2.1-7.0 observations/patient). Length of stay was similar (pathway 16.7 h vs no pathway 15.3 h, difference 1.4 h, 95% CI -2.4 to 5.9 h). Conclusions Following the introduction of a dedicated opioid poisoning nursing care pathway, naloxone delivery and observation documentation increased. A care pathway may improve ED management of opioid poisoning.