21.11.14
Patient safety alert issued on opiate treatment overdosing
NHS England has issued a patient safety alert relating to the risk of harm or death from inappropriate doses of naloxone in patients on long-term opioid or opiate treatment.
This is in particular relation to where the drug is being used to provide relief from both chronic and acute pain, such as following surgery.
In cases where opioid or opiate treatments have caused semi-consciousness or unconsciousness, particularly when dangerously shallow or slow breathing occurs, naloxone can be used as a rapid treatment to completely or partially reverse the effect of the opioid or opiate.
Within the alert it stated that naloxone must be given with great caution to patients who have received longer-term opioid/opiate treatment for pain control or who are physically dependent on opioids/opiates.
The British National Formulary (BNF) recommends a dose range to reverse acute opioid/opiate overdose in adults by intravenous injection of naloxone of 400 micrograms to 2mg. If there is no response, the dose is to be repeated at intervals of two to three minutes to a maximum of 10mg.
However, the BNF highlights that doses used in acute opioid/opiate overdose may not be appropriate for the management of opioid/opiate induced respiratory depression and sedation in those receiving palliative care and in chronic opioid/opiate use.
NHS England has received details of three patient safety incidents describing failure to follow the BNF guidance, including two incidents that resulted in death. “Because this risk appears under-recognised, there may be significant under-reporting,” it added.
The patient safety alert has stated that all organisations providing NHS-funded care where naloxone is prescribed, dispensed and/or administered must:
- Establish if incidents involving inappropriate use of naloxone have occurred or have the potential to occur in their organisation.
- Consider if immediate action needs to be taken locally and ensure that an action plan is underway, if required, to reduce the risk of further incidents occurring.
- Disseminate the Alert to clinical staff who prescribe, dispense or administer naloxone injection.
These actions must happen as soon as possible, but no later than 22 December 2014.
NHS England noted that additional safeguards that have been locally implemented include raising awareness of the risk of inappropriate doses of naloxone, the use of lower doses of naloxone in clinical protocols and resuscitation drug trays, teaching correct use of naloxone in annual cardiopulmonary resuscitation training sessions, and providing guidance on clinical monitoring and access to specialist pain relief advice after naloxone administration.
(Image: c. Hospira)
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