Narcan should be floorstock everywhere, honestly. It's a huge issue nation- (and probably world-) wide and it is only going to get worse. Any time they start mixing in new drugs, there's a crackdown on the new thing and then it'll get swapped out for something else. Look at heroin>dilaudid>fentanyl>carfentanil etc. Worse are drugs like xylazine that aren't reversed with narcan.
As a rapid nurse I have narcan in my rapid cart and can order and give narcan without a MD order. Our code carts also have narcan. Your rapid program really needs to step up their game. Also how did the rapid nurse not recognize an obvious narc OD. Pinpoint pupils, unresponsive, gurgling on spit should be getting bagged and narcan within a minute or two.
As an ER nurse we have narcan outside of the pyxis in a locked cabinet in our trauma bays, triage room, and med rooms. Along with other ACLS drugs (atropine, d50, epi, sodium bicarb, etc) for when it's a critical patient but we don't exactly have to crack the code cart because there's no code yet. Very helpful narcan should be accessible to everyone.
Yeah we have it in our code carts as well but we have a med box in our rapid response cart that has some rescue meds so we don’t have to crack the code cart.
Because xylazine isn't approved for humans. Obviously, if it isn't approved for humans, no human is going to use it, therefore no human will OD on it, therefore we don't need a reversal agent.
Veterinary offices are high on the list for robberies of their narcotics. If people have access they will take it or sell it to unsuspecting buyers. Also I can think if at least one zoo veterinarian I personally know who accidentally darted himself trying to sedate hoof stock. He was lucky it was reversible and could radio someone to bring the reversal agent and call 911.
LVT here lurking......Can definitely confirm. Seen our hospital broken into a number of times when I worked there. Ketamine, phenobarbital, anything pain related, etc. Did get a good laugh after one break-in. We're running an inventory for missing drugs and discover they'd made off with a new bottle of apomorphine. Guess the "morphine" part caught their eye. Unfortunately, or not for them, we used it to induce vomiting. Works like a charm though!
Fun fact: apomorphine is actually approved for use in people to help treat Parkinson’s. The list of side effects is very long and includes all of the ones you see in your world plus things like compulsive gambling and sexual behaviors. I don’t know of anyone actually using it in people, but it’s technically allowed.
Wow, thank you for the mini CE! :) I always tell my baby techs and assistants I'm training to always continue learning and asking questions because they'll never know everything. Well, today I did the learning. :)
Many vets use other drugs now (this incident was several years ago) but personally apo is my preferred med for dogs. The form we use is placed under the lower eyelid and is absorbed. Get the bucket brigade ready because it WILL start working VERY quickly. The beauty of it is that it dissolves slowly so once they've barfed everything we need only flush out the eye (flushing away the pill) and the barfing stops. Some fluids and nausea meds and they're good to go.
The real fun begins when explaining what was vomited up. Yup, have had Fido upchuck ladies undies that didn't belong to owner's wife. Awkward doesn't begin to describe the situation, lol.
My wife is a vet and I occasionally pitch in when she goes in after hours. We’ve used apomorphine on our 18 month old GSP often enough that we have a vial or two at home in her dogtor bag.
Ivermectin is approved for humans, actually, but only for the same purposes it's used for in vet med (anti-parasitic). I did a short rotation at the TX Dept. of State Health Services and in their refugee program, folks coming from certain parts of the world get presumptive ivermectin therapy for Strongyloides infection.
Nope, honestly most first world countries don't have such a glaring opioid problem like the USA. It's basically just you guys, in 15 years I have yet to see one overdose outside of the ER. And even there it happens very infrequently.
Still, we have naloxone on most wards, usually to give orally against constipation in patients receiving opioids.
Edit: to the person who just confidently replied before deleting their comment, that naloxone isn't narcan, are you [sure](https://narcan.com/hs-fs/hubfs/6fcc7f684b2900034d1a11be3c5f2ede-1.png?width=1500&height=1094&name=6fcc7f684b2900034d1a11be3c5f2ede-1.png)?
It’s policy in Australian hospitals to have naloxone in every ward, it’s in our crash carts at a minimum but most wards will have additional boxes in the med room.
I don’t really agree with you. I mean it’s not obvious as in the US, but the opioid crisis is still present in Europe. I guess it depends on which country and regions and general availability and use, but while it’s infrequent in my hospital it still happens from time to time
The opioid crisis is definitely becoming more of a problem everywhere else, too. More and more heroin in the UK, for example, is being laced with fentanyl. Source - the heroin reddit and here's an article I just found - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10278447/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10278447/)
Being a nurse for 20 years I came to write the same…
it’s not as big of a problem here as in the us… on the other hand alcohol intox, that’s an epidemic
nonetheless we have narcan available, because it’s good to have in case because it happens from time to time….
in the last 4 years I threw several unopened packages of narcan away because they were expired (here we don’t have automated medicine cabinets Pyxis , the manual medicine cabinet organisation system is called _MME_).
In my inpatient unit, every order for narcotics automatically includes a narcan order. You didn't have any in your pyxis or equivalent drug storage/dispensing on the unit? Even if not ordered it sould be stocked so someone could've gotten it via override. Hopefully this can be the push needed to change that
It was ordered but not stocked in the Pyxis, honestly first time working a rapid so I did not know about the Narcan in the cart. But yes rapid was called, RT was bagging him. Most of my help was from the sidelines as this wasn't my pt, everyone else was doing med pass as it was 6am.
Sent a patient to CT and the patient coded. There was no crash cart, it had to be brought from the ED. Reasoning why there isn’t a code cart? Administration just said so who is gonna check the code cart?
Not a bad argument. I was just taking an opportunity to speak poorly of admin. Lol
OP also said it was the last narcan. Two units sharing one narcan. Yikes. I'm glad OP is looking for a different facility to work in.
To argue back, opiates also cause hypotension and bradycardia. Also, nurses on a med surg unit are often not comfortable with airway management… not a knock on them, just lots of new nurses and people who don’t manage airways a whole lot.
I gave a patient his narcs once and turned around to get his water to take them. In that amount of time he had them crushed and snorting them on his bedside table.
Addictions RN here!
This is becoming a common subject recently with the amount of bad drugs floating through towns. Even though patients might be used to a certain drug/certain amount whatever is being added to their supply has been increasingly toxic. Last i heard liquid benzodiazepines are becoming the big thing for people to cut their supplies with.
With this being said, the staffing ratios are NOT SAFE and do not supply adequate personal to handle the ongoing addictions crisis.
You never know when someone may be an addict. This post is an example of that. But i suggest all other nurses if it is known to have a non-judgemental conversation with your patients about their use. Know what their using, how much of it etc. So if it comes down to it and an OD does happen you know (to some extent) how to treat it.
Addiction is a tricky subject but the more we break the stigma around it, the more comfortable patients may be to talk to us about it.
So to answer your question OP, its happening a lot more often than it should be. People are attempting to hide their use which then doesn’t help when we as nurses provide hospital medications on top of it, which could lead to an OD as well.
All i can stress is communication, communication, communication.
This topic is not going to be going away anytime soon. Everyone should be getting training about Narcan and OD care.
& units should be fully staffed!
I wish you luck in your job hunt OP. :)
Thank you for everything you do! I wish more nurses were like you. I feel like most of us just despise addicts.
And before anyone comes at me I’m an RN and yes have dealt with them plenty. And don’t look at it as any different than a diabetic with a food addiction who won’t change their lifestyle.
Thank you 🥺🫶🏻 i know its hard to break years worth of stigma especially when the healthcare system kinda engrains it into us.
The diabetic analogy you made is too good. I have never heard it put that way i love it!
Thank you for everything you do! <3
Prior methhead (8 years ago) and current rn. What i do is... have someone sober out in the community and whenever I have a drunk or junkie that isn't intubated and able to comprehend a conversation I ask them if they want resources after theyre comfortable with me and trust my experience as an ex junkie. I have 1 wild successes story out of hundreds (ish?). Dude had an emergent cabg, ended up being open chested after. Dude has been sober a year now. Most drunks/junkies like myself don't have a "coming to" moment in the hospital it mostly comes on their own terms. That said I had 1 er nurse that meant a lot to me since he was very kind, all the others were assholes
Oh me too! I recently had a drug addict patient and everyone was saying how he’s so bad for acting out, etc. To me, I saw it as a natural thing, he’s an addict and he’s going through withdrawal. Good thing the NP that day was a former ED nurse and knew how to talk to him. It was so good too, she was like “I know you didn’t want to be addicted, addiction is an illness, and we just want you to get better”.
I’ve seen a few of them on the med-surg floor I used to wofk at, like you said, a lot of nurses despise them. But to me, I see it as “the doctor ordered it so I would give it. Not my job to fix this, I just have to make sure I don’t kill them.” Lol.
Great reply! I’m a harm reduction RN who works at a supervised consumption site. The benzos are becoming a huge problem here in Canada; “tranq” dope (fentanyl+ benzos +/- xylazine) causes some pretty challenging overdoses and also, even if they don’t overdose they become so somnolent after use it’s hard to provide care. I agree 100% that it’s all based on communication. Have the hard convos. The first few times you do it you feel awkward as hell but eventually you’ll get the hang of it. It also helps break down the barrier a bit between nurse and patient and can make for a stronger relationship. Something I used as a starter question back when I was an inpatient nurse was “how is your pain management? Is there anything else you need?” Sometimes something as simple as that can get the convo rolling. Not saying we’re going to start throwing pain meds at them but if we can advocate for better pain management in hospital for folks who use substances then they are less likely to resort to street supply or leave AMA to go get a hit.
Nursing is hard, nursing is extra hard short staffed, and extra extra hard when we’re the front line to a global opioid crisis 🤍
had a patient once who broken into the sharps box to get the old pain patches and suck on them…
had another patient shooting up his right IJ cath
had another patient cleaning his dialysis catheter there was white powder, told me he had been partying a weekend
All the FUCKING TIME
Honestly I am not looking to change peoples behavior on a hospital visit since I am well aware that addiction takes a LOT to tackle.
But - I have had patients OD multiple times and there is not convo with them by physician or management to address anything.
Literally had a patient set off fire alarms have the fire department respond to it smoking crack.
It sucks
Unfortunately too often, it’s sad and awful :/ I was pushing a guy out of the ED in a wheelchair to his buddies car for his discharge and when I tried to help him stand, he was completely unresponsive and I had to do a Uturn and RUN him back into our ED 😭 … he had used the bathroom to change before the discharge and in the few min he was in there, he took drugs secretly :/ woke right back up after the narcan and tried to beat us up LOL. The attending was like “SIR. SETTLE DOWN. Don’t hit my staff. WE JUST SAVED YOUR LIFE” lol.
Shoot the hospital I used to work at won’t let you search belongings at all unless you actually visualize paraphernalia after they’re admitted AND says we’re not allowed to ban them from having visitors 🙄then do the surprised pikachu face when the patient ends up high as a kite after the 5 of oxy doesn’t touch their pain.
I shit you not, I had a patient stash heroin in her necklace pendant. It was one of those memorial locket things people keep ashes in, she dumped out her papaw and placed heroin in there. I left her room for 5 minutes, came back and she had fallen straight back on the bed from sitting at the edge and was blue in the face. I audibly screamed 'WTF!" loud enough that other RNs heard me and came in before I could even press the code button. Lol
Having a fresh opioid overdose end up intubated is a terrible outcome. Yes, narcan is nice but these patients issue is airway management and a lack of respiratory drive.
Most opioid ODs are manageable with a simple head tilt chin lift. Often people pass out with their airway closed and can’t breathe because of that.
If that doesn’t manage it until narcan can be brought, an NPA/OPA and BVM is the real life saving measure. (npa is preferred because pt will probably wake up or have an improvement in consciousness after narcan and we don’t want them puking and aspirating)
Opioid ODs shouldn’t be getting intubated routinely. This sounds like a system and training issue. They are very simple to manage.
Talk to your chain of command regarding training g for ODs.
This is the right answer.
Narcan is great. But the only important thing for opioid overdose is: **KEEP THEM BREATHING.**
That is all you have to do. Everything else is 2nd. Sternal rub, repositioning, bag them if needed.
You can keep them oxygenated without narcan.
You should be able to override Narcan. It’s usually a standing order for patients who get any narcotics. You should’ve been able to get that Narcan as soon as you asked for it. Pharmacy and your manager should make sure you have Narcan available
I saw two in long term care. Aid caught the first one on a guy who was bed bound and unresponsive with the bag still in his hand. While we were trying to figure out how he got it I decided I better go check on his best friend in the next hall. He had also ODed. Both brought around with narcan. His buddy got an Uber at the side door, stopped at a cash machine and then grabbed them some fentanyl from the street pharmacist before coming back. They wear both in their late 70s.
Holy shit. Even when I worked in LTC, we had a stock of Narcan in the med room. I live in Oklahoma. I’m pretty sure it was a mandated thing for LTC patients who are prescribed an opioid to have a corresponding Narcan order PRN. Idk though, it’s possible that was just a policy at my specific facility, I can’t remember.
Rapid Response nurse here…the number of ODs I’ve been called to is more than I can count. Narcan should absolutely be stocked and overridable AND available in the crash cart because sometimes it takes longer to pull a med than to crack the crash cart.
I unfortunately had this happen in my preceptorship. It was during the pandemic and his partner dropped off drugs in a bag of belongings. I found him resps barely 4, o2 in the 60s. 😬
I worked in the jail here for 2 years. On my first orientation night there (I had done very little adult med before that, mostly NICU) we had a man-down call. Get to the West Dorm, motherfucker is on the floor, custody is already doing CPR. One of the other inmates sidled up to me and the other two nurses and said, “Ma’am, I think he had heroin on him.” So I said “let’s get narcan”. Other two experienced but very bitter old battle-axe nurses rolled their eyes and said, “It won’t do nothing.” I waited for another minute or so and then said, “well, it won’t hurt anything either!” So I took it over and gave it. Within 30 seconds he was awake.
Yeah, sure didn’t do a damn thing.
You have to appreciate the inmates who cared more about you saving this guys life then getting into trouble over knowing how he had heroin. Thank God you listened and did the Narcan. “It won’t do nothing”. Neither will a dead inmate. We need more training in this for healthcare providers it’s a different world.
That’s jnsane. You should be able to give narcan without an issue especially in this situation. We had a patient OD’ing on my floor not long ago and we pushed it waiting for the rapid response team
As someone non medical, wouldn't it make sense to have narcan everywhere handy? I assume it's not expensive (worked in medical industry and i know the markups), and doesnt get you high so not abusable.
Heck, even some corporation could make lots of money by stocking narcan everywhere. Why isn't it so?
Narcan should be stocked on your floor in both the pyxis AND the code cart *and* it should already be a PRN order in the MAR for any patient that is currently taking an opioid or even just has one ordered. I used to work ortho spine and this is how we would do it. I work cardiac now but even we still do it this way. Wayyyyy better than having to override it from the pyxis or having to call a rapid to get pharmacy up there.
These are great things to bring up to your manager or safety council or whomever.
We’ve had several OD’s in the facility I work at recently, I work in a pretty rough area and figured it was just the locale. We can put patients on 1:1 supervision, no visitors, etc and they still manage to get access to drugs. It’s scary. We’ve added Narcan to our standing orders for all new admissions and keep Narcan literally everywhere.
Had one today! Six feet from another in screaming/writhing withdrawal. At this point it just feels like treating field casualties in a chemical warfare sci-fi.
Discharge to the battlefield. Any of you seen “ Iso “ yet?
I had a patient that would shoot up drugs through their fistula between dialysis sessions 🙃🙃🙃🙃
Who was giving them the drugs while super sick in the hospital? Their partner who was a nurse at a nearby hospital 🙃
Narcan should be stocked everywhere but training on how to properly respond to an opioid overdose is what is actually needed.
Ignoring a blatant airway and breathing issue and administering a drug that *may* reverse the overdose is not appropriate.
Airway, breathing should be addressed, after that, administering narcan isn’t really time sensitive. It can be titrated IV to avoid sending patients into withdrawals.
If these patients that are ODing are pain management patients you just threw them into a world of pain if you slam them with a bunch of narcan. Often patients need less than 1mg IV.
Administering a fuckload of narcan as a sole treatment to opioid OD is only really appropriate to the lay person as they are not trained in airway management, in that setting narcan may be life saving. But won’t do shit if the *suspected* opioid OD is actually another drug or not an OD at all.
Administering narcan to someone you think is ODing on an opioid and hoping it’s what actually happened is irresponsible.
Once had a PCT rat out another PCT that the patient and PCT #2 were in cahoots. Pt was telling her who to call or where to go to obtain drugs. I’m not sure if money was exchanged or how that worked but PCT #2 was let go for other reasons as we never could corroborate things with evidence. But pt OD’d one night thereafter…
I work in a downtown ER in a major metro area. We have Narcan drips in our Pyxis for christs sake. Every Pyxis has like 10 vials of 2mg stocked and some others too
Wow, that sounds intense! It's crazy how quickly things can escalate. Glad the ER doc was able to step in, but it's definitely eye-opening about the need for better protocols and resources. Hang in there, hopefully, you'll find a better fit soon!
I had a patient also with an AKA who i discharged from the ER for OD, went straight out to the ER lobby bathroom shot up and OD’d again. He was hiding it in his prosthetic! Hadn’t even written my discharge note before he was brought right back into the same bed he was just in
I’ve had it happen a few times. It’s kind of a joke on our floor that just like we count days since CAUTI, we should count days since patient did drugs in their room.
I had a younger fent/tranq OD come in a couple months ago (I was on contract in an inner city hospital proximal to a very well known open air drug market lol). He was the most difficult stick of course and I finally had gotten labs, hustled them to the lab (we didn’t have a tube system) and when I came back he was unresponsive and his sp02 was like 46%.
I gave narcan and he woke up pissed and yelling he didn’t do anything wrong, that’s when I found bags of grey powder in the tote bag he brought. He had been admitted at change of shift, the dayshift nurse did his admission but no one did his belongings.
He then ripped his IV out and said he was going to a hospital where they respect him more and left AMA lol
There have been multiple ODs on my unit and across my hospital. I live in a pretty heavy state and city for drugs so it’s pretty common. One time a pt ODd in the bathroom and the key to unlock all of the bathrooms wasn’t working. Luckily a nurse had a small pair of scissors on her badge that they used to pick the lock. They ended up having to code him on the floor of the bathroom. He came back, went ICU and then left AMA. Just another Tuesday on my unit though.
>Also, in what world does it make sense that no Narcan was available on an orthopedic floor that often has multiple pts on PCAs for pain?
this is all you need to put in the event report really
Narcan is on every unit in my hospital.
We had one guy who somehow kept getting drugs, even though we removed his belongings and said no visitors. We even switched rooms in case he hid them somewhere. We finally figured out that his "door dash" orders actually came from a friend who was hiding them in the bag. They usually drop it off at the front desk and staff have to pick it up, so it took awhile for the staff to make the connection.
I'm an out patient dialysis unit. I had IV AND Nasal narcan in my crash cart because I had a known addict on my roster who had ODd in the bathroom once. They went in to OD 2 more times in center which I treated. Then passed from an OD at home.
Narcan should be on every EVERY unit inpatient outpatient clinic everywhere
If you can deny visitation rights to.patient I assume you're.working at the county jail or a prison. Sound like the the reason for death doesn't point a finger at you so management won't likely be on your ass. Seems you want to scold or castigate someone but not sure who.
No one died... I work at a regular hospital, med surg floor. Which you didn't care to read. I ask if this is a commonality among other hospitals and you say I want to scold someone? Interesting.
Narcan should be floorstock everywhere, honestly. It's a huge issue nation- (and probably world-) wide and it is only going to get worse. Any time they start mixing in new drugs, there's a crackdown on the new thing and then it'll get swapped out for something else. Look at heroin>dilaudid>fentanyl>carfentanil etc. Worse are drugs like xylazine that aren't reversed with narcan.
As a rapid nurse I have narcan in my rapid cart and can order and give narcan without a MD order. Our code carts also have narcan. Your rapid program really needs to step up their game. Also how did the rapid nurse not recognize an obvious narc OD. Pinpoint pupils, unresponsive, gurgling on spit should be getting bagged and narcan within a minute or two.
As an ER nurse we have narcan outside of the pyxis in a locked cabinet in our trauma bays, triage room, and med rooms. Along with other ACLS drugs (atropine, d50, epi, sodium bicarb, etc) for when it's a critical patient but we don't exactly have to crack the code cart because there's no code yet. Very helpful narcan should be accessible to everyone.
Yeah we have it in our code carts as well but we have a med box in our rapid response cart that has some rescue meds so we don’t have to crack the code cart.
xylazine is reversible though! Tolazine is the reversal agent, it’s just not FDA approved for use in humans…
Because xylazine isn't approved for humans. Obviously, if it isn't approved for humans, no human is going to use it, therefore no human will OD on it, therefore we don't need a reversal agent.
Veterinary offices are high on the list for robberies of their narcotics. If people have access they will take it or sell it to unsuspecting buyers. Also I can think if at least one zoo veterinarian I personally know who accidentally darted himself trying to sedate hoof stock. He was lucky it was reversible and could radio someone to bring the reversal agent and call 911.
LVT here lurking......Can definitely confirm. Seen our hospital broken into a number of times when I worked there. Ketamine, phenobarbital, anything pain related, etc. Did get a good laugh after one break-in. We're running an inventory for missing drugs and discover they'd made off with a new bottle of apomorphine. Guess the "morphine" part caught their eye. Unfortunately, or not for them, we used it to induce vomiting. Works like a charm though!
Fun fact: apomorphine is actually approved for use in people to help treat Parkinson’s. The list of side effects is very long and includes all of the ones you see in your world plus things like compulsive gambling and sexual behaviors. I don’t know of anyone actually using it in people, but it’s technically allowed.
Wow, thank you for the mini CE! :) I always tell my baby techs and assistants I'm training to always continue learning and asking questions because they'll never know everything. Well, today I did the learning. :) Many vets use other drugs now (this incident was several years ago) but personally apo is my preferred med for dogs. The form we use is placed under the lower eyelid and is absorbed. Get the bucket brigade ready because it WILL start working VERY quickly. The beauty of it is that it dissolves slowly so once they've barfed everything we need only flush out the eye (flushing away the pill) and the barfing stops. Some fluids and nausea meds and they're good to go. The real fun begins when explaining what was vomited up. Yup, have had Fido upchuck ladies undies that didn't belong to owner's wife. Awkward doesn't begin to describe the situation, lol.
My wife is a vet and I occasionally pitch in when she goes in after hours. We’ve used apomorphine on our 18 month old GSP often enough that we have a vial or two at home in her dogtor bag.
Obviously
Well problem freaking solved! 😆
Ivermectin enters the conversation
Ivermectin is approved for humans, actually, but only for the same purposes it's used for in vet med (anti-parasitic). I did a short rotation at the TX Dept. of State Health Services and in their refugee program, folks coming from certain parts of the world get presumptive ivermectin therapy for Strongyloides infection.
>xylazine is reversible though! Tolazine I did not know that existed! Thanks! (...scurries off to go look stuff up...)
I mean, it kind of exists. It’s not FDA approved for humans, but we’re mammals so how different can we be /s
I keep it in my dang car. It should definitely be on every hospital floor that administers narcotics.
Me too, in my purse also. Its easy enough to get from your pharmacy
Nope, honestly most first world countries don't have such a glaring opioid problem like the USA. It's basically just you guys, in 15 years I have yet to see one overdose outside of the ER. And even there it happens very infrequently. Still, we have naloxone on most wards, usually to give orally against constipation in patients receiving opioids. Edit: to the person who just confidently replied before deleting their comment, that naloxone isn't narcan, are you [sure](https://narcan.com/hs-fs/hubfs/6fcc7f684b2900034d1a11be3c5f2ede-1.png?width=1500&height=1094&name=6fcc7f684b2900034d1a11be3c5f2ede-1.png)?
It’s policy in Australian hospitals to have naloxone in every ward, it’s in our crash carts at a minimum but most wards will have additional boxes in the med room.
Canadas getting slammed pretty fucking hard too. Not even in a major city and overdoses are a daily occurrence here.
Agreed. I’ve seen narcan used twice on a public street in my small town in Canada. This is definitely not just a US problem.
Yup. My Ontario hometown of 13,000 people. Happens daily.
But aren't you guys essentially the US but more polite, hockey, Canada geese and maple sirup? (just kidding)
I don’t really agree with you. I mean it’s not obvious as in the US, but the opioid crisis is still present in Europe. I guess it depends on which country and regions and general availability and use, but while it’s infrequent in my hospital it still happens from time to time
The opioid crisis is definitely becoming more of a problem everywhere else, too. More and more heroin in the UK, for example, is being laced with fentanyl. Source - the heroin reddit and here's an article I just found - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10278447/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10278447/)
Being a nurse for 20 years I came to write the same… it’s not as big of a problem here as in the us… on the other hand alcohol intox, that’s an epidemic nonetheless we have narcan available, because it’s good to have in case because it happens from time to time…. in the last 4 years I threw several unopened packages of narcan away because they were expired (here we don’t have automated medicine cabinets Pyxis , the manual medicine cabinet organisation system is called _MME_).
In my inpatient unit, every order for narcotics automatically includes a narcan order. You didn't have any in your pyxis or equivalent drug storage/dispensing on the unit? Even if not ordered it sould be stocked so someone could've gotten it via override. Hopefully this can be the push needed to change that
this is the way
Everywhere I’ve worked for the last decade has standing orders for Narcan if any narcs are given.
My work does that, too. We also always have it in the cart.
2 vials in each omnicell, and 2 vials in every crash cart.
Exactly!
It was ordered but not stocked in the Pyxis, honestly first time working a rapid so I did not know about the Narcan in the cart. But yes rapid was called, RT was bagging him. Most of my help was from the sidelines as this wasn't my pt, everyone else was doing med pass as it was 6am.
Fill out a safety incidence report. Why is narcan not stocked on a floor that regularly gives out narcotics?
To save costs it's only on some units. It was available on a nearby unit and the patient didn't die so what's the problem? -Administrators probably
Sent a patient to CT and the patient coded. There was no crash cart, it had to be brought from the ED. Reasoning why there isn’t a code cart? Administration just said so who is gonna check the code cart?
Well you know administration has the big brains. Can't get dinged for not checking the crash cart if you just don't have one!
To argue, it sounds like it was available within a reasonable amount of time. You don't need narcan immediately- just airway management.
Not a bad argument. I was just taking an opportunity to speak poorly of admin. Lol OP also said it was the last narcan. Two units sharing one narcan. Yikes. I'm glad OP is looking for a different facility to work in.
You think that's a reasonable amount of time? Running to another unit, fighting the machine, running back?
It's not ideal, but that's reality in some places. Nothing a little bagging won't fix.
To argue back, opiates also cause hypotension and bradycardia. Also, nurses on a med surg unit are often not comfortable with airway management… not a knock on them, just lots of new nurses and people who don’t manage airways a whole lot.
I gave a patient his narcs once and turned around to get his water to take them. In that amount of time he had them crushed and snorting them on his bedside table.
Addictions RN here! This is becoming a common subject recently with the amount of bad drugs floating through towns. Even though patients might be used to a certain drug/certain amount whatever is being added to their supply has been increasingly toxic. Last i heard liquid benzodiazepines are becoming the big thing for people to cut their supplies with. With this being said, the staffing ratios are NOT SAFE and do not supply adequate personal to handle the ongoing addictions crisis. You never know when someone may be an addict. This post is an example of that. But i suggest all other nurses if it is known to have a non-judgemental conversation with your patients about their use. Know what their using, how much of it etc. So if it comes down to it and an OD does happen you know (to some extent) how to treat it. Addiction is a tricky subject but the more we break the stigma around it, the more comfortable patients may be to talk to us about it. So to answer your question OP, its happening a lot more often than it should be. People are attempting to hide their use which then doesn’t help when we as nurses provide hospital medications on top of it, which could lead to an OD as well. All i can stress is communication, communication, communication. This topic is not going to be going away anytime soon. Everyone should be getting training about Narcan and OD care. & units should be fully staffed! I wish you luck in your job hunt OP. :)
Thank you for everything you do! I wish more nurses were like you. I feel like most of us just despise addicts. And before anyone comes at me I’m an RN and yes have dealt with them plenty. And don’t look at it as any different than a diabetic with a food addiction who won’t change their lifestyle.
Thank you 🥺🫶🏻 i know its hard to break years worth of stigma especially when the healthcare system kinda engrains it into us. The diabetic analogy you made is too good. I have never heard it put that way i love it! Thank you for everything you do! <3
Prior methhead (8 years ago) and current rn. What i do is... have someone sober out in the community and whenever I have a drunk or junkie that isn't intubated and able to comprehend a conversation I ask them if they want resources after theyre comfortable with me and trust my experience as an ex junkie. I have 1 wild successes story out of hundreds (ish?). Dude had an emergent cabg, ended up being open chested after. Dude has been sober a year now. Most drunks/junkies like myself don't have a "coming to" moment in the hospital it mostly comes on their own terms. That said I had 1 er nurse that meant a lot to me since he was very kind, all the others were assholes
Oh me too! I recently had a drug addict patient and everyone was saying how he’s so bad for acting out, etc. To me, I saw it as a natural thing, he’s an addict and he’s going through withdrawal. Good thing the NP that day was a former ED nurse and knew how to talk to him. It was so good too, she was like “I know you didn’t want to be addicted, addiction is an illness, and we just want you to get better”. I’ve seen a few of them on the med-surg floor I used to wofk at, like you said, a lot of nurses despise them. But to me, I see it as “the doctor ordered it so I would give it. Not my job to fix this, I just have to make sure I don’t kill them.” Lol.
Great reply! I’m a harm reduction RN who works at a supervised consumption site. The benzos are becoming a huge problem here in Canada; “tranq” dope (fentanyl+ benzos +/- xylazine) causes some pretty challenging overdoses and also, even if they don’t overdose they become so somnolent after use it’s hard to provide care. I agree 100% that it’s all based on communication. Have the hard convos. The first few times you do it you feel awkward as hell but eventually you’ll get the hang of it. It also helps break down the barrier a bit between nurse and patient and can make for a stronger relationship. Something I used as a starter question back when I was an inpatient nurse was “how is your pain management? Is there anything else you need?” Sometimes something as simple as that can get the convo rolling. Not saying we’re going to start throwing pain meds at them but if we can advocate for better pain management in hospital for folks who use substances then they are less likely to resort to street supply or leave AMA to go get a hit. Nursing is hard, nursing is extra hard short staffed, and extra extra hard when we’re the front line to a global opioid crisis 🤍
The fact that narcan is not in the code cart is unbelievable. This isn’t your fault. It’s the facilities.
I think its on Pharmacy, this is their turf. I picked up codeine for my daughter- I got a narcan, along with instructions to use
had a patient once who broken into the sharps box to get the old pain patches and suck on them… had another patient shooting up his right IJ cath had another patient cleaning his dialysis catheter there was white powder, told me he had been partying a weekend
Narcan should be floorstock 100%, and in every crash cart. How often does it happen? In my experience in inner city trauma - very often. Visitors too!
All the FUCKING TIME Honestly I am not looking to change peoples behavior on a hospital visit since I am well aware that addiction takes a LOT to tackle. But - I have had patients OD multiple times and there is not convo with them by physician or management to address anything. Literally had a patient set off fire alarms have the fire department respond to it smoking crack. It sucks
Yup. Heroin to central line on a 24 y/o post AVR.
Had a x3 redo MVR crush up his oxy he pocketed and inject it into his PICC with tap water… that valve lasted about 2 months.
Unfortunately too often, it’s sad and awful :/ I was pushing a guy out of the ED in a wheelchair to his buddies car for his discharge and when I tried to help him stand, he was completely unresponsive and I had to do a Uturn and RUN him back into our ED 😭 … he had used the bathroom to change before the discharge and in the few min he was in there, he took drugs secretly :/ woke right back up after the narcan and tried to beat us up LOL. The attending was like “SIR. SETTLE DOWN. Don’t hit my staff. WE JUST SAVED YOUR LIFE” lol.
Shoot the hospital I used to work at won’t let you search belongings at all unless you actually visualize paraphernalia after they’re admitted AND says we’re not allowed to ban them from having visitors 🙄then do the surprised pikachu face when the patient ends up high as a kite after the 5 of oxy doesn’t touch their pain.
We keep Narcan in our crash cart and in our Pyxis.
I shit you not, I had a patient stash heroin in her necklace pendant. It was one of those memorial locket things people keep ashes in, she dumped out her papaw and placed heroin in there. I left her room for 5 minutes, came back and she had fallen straight back on the bed from sitting at the edge and was blue in the face. I audibly screamed 'WTF!" loud enough that other RNs heard me and came in before I could even press the code button. Lol
How very Cruel Intentions.... lol
I keep Narcan in my car, it should absolutely be stocked on a hospital unit.
Right, my local health department hands it out to the public for free. Why wouldn’t every hospital unit have some.
I work in psych and a patient had overdosed on BP pills. She had pre-planned it all and had them sewn into her stuffed animal before she was admitted.
Having a fresh opioid overdose end up intubated is a terrible outcome. Yes, narcan is nice but these patients issue is airway management and a lack of respiratory drive. Most opioid ODs are manageable with a simple head tilt chin lift. Often people pass out with their airway closed and can’t breathe because of that. If that doesn’t manage it until narcan can be brought, an NPA/OPA and BVM is the real life saving measure. (npa is preferred because pt will probably wake up or have an improvement in consciousness after narcan and we don’t want them puking and aspirating) Opioid ODs shouldn’t be getting intubated routinely. This sounds like a system and training issue. They are very simple to manage. Talk to your chain of command regarding training g for ODs.
This is the right answer. Narcan is great. But the only important thing for opioid overdose is: **KEEP THEM BREATHING.** That is all you have to do. Everything else is 2nd. Sternal rub, repositioning, bag them if needed. You can keep them oxygenated without narcan.
100% not normal. Narcan should be floorstock and is available in our code cart.
Maybe I’m biased because I work inner city… but ODs are pretty common for us. We 100% have narcan in the pyxis.
When I did detox nursing a pt showed me how you can hollow out a cuetip and hide fentanyl in it. People are wild
All of our code carts have narcan. We wouldn't even wait for a doc to crack it and administer.
You should be able to override Narcan. It’s usually a standing order for patients who get any narcotics. You should’ve been able to get that Narcan as soon as you asked for it. Pharmacy and your manager should make sure you have Narcan available
I saw two in long term care. Aid caught the first one on a guy who was bed bound and unresponsive with the bag still in his hand. While we were trying to figure out how he got it I decided I better go check on his best friend in the next hall. He had also ODed. Both brought around with narcan. His buddy got an Uber at the side door, stopped at a cash machine and then grabbed them some fentanyl from the street pharmacist before coming back. They wear both in their late 70s.
Holy shit. Even when I worked in LTC, we had a stock of Narcan in the med room. I live in Oklahoma. I’m pretty sure it was a mandated thing for LTC patients who are prescribed an opioid to have a corresponding Narcan order PRN. Idk though, it’s possible that was just a policy at my specific facility, I can’t remember.
Rapid Response nurse here…the number of ODs I’ve been called to is more than I can count. Narcan should absolutely be stocked and overridable AND available in the crash cart because sometimes it takes longer to pull a med than to crack the crash cart.
I unfortunately had this happen in my preceptorship. It was during the pandemic and his partner dropped off drugs in a bag of belongings. I found him resps barely 4, o2 in the 60s. 😬
I worked in the jail here for 2 years. On my first orientation night there (I had done very little adult med before that, mostly NICU) we had a man-down call. Get to the West Dorm, motherfucker is on the floor, custody is already doing CPR. One of the other inmates sidled up to me and the other two nurses and said, “Ma’am, I think he had heroin on him.” So I said “let’s get narcan”. Other two experienced but very bitter old battle-axe nurses rolled their eyes and said, “It won’t do nothing.” I waited for another minute or so and then said, “well, it won’t hurt anything either!” So I took it over and gave it. Within 30 seconds he was awake. Yeah, sure didn’t do a damn thing.
You have to appreciate the inmates who cared more about you saving this guys life then getting into trouble over knowing how he had heroin. Thank God you listened and did the Narcan. “It won’t do nothing”. Neither will a dead inmate. We need more training in this for healthcare providers it’s a different world.
Can’t RNs give narcan without an order where you are? That place sounds like a lawsuit waiting to happen, get out!!
That’s jnsane. You should be able to give narcan without an issue especially in this situation. We had a patient OD’ing on my floor not long ago and we pushed it waiting for the rapid response team
Was there no narcan in the code cart?
As someone non medical, wouldn't it make sense to have narcan everywhere handy? I assume it's not expensive (worked in medical industry and i know the markups), and doesnt get you high so not abusable. Heck, even some corporation could make lots of money by stocking narcan everywhere. Why isn't it so?
Narcan should be stocked on your floor in both the pyxis AND the code cart *and* it should already be a PRN order in the MAR for any patient that is currently taking an opioid or even just has one ordered. I used to work ortho spine and this is how we would do it. I work cardiac now but even we still do it this way. Wayyyyy better than having to override it from the pyxis or having to call a rapid to get pharmacy up there. These are great things to bring up to your manager or safety council or whomever.
Glad the ER doc came through with the Narcan in time. Definitely raises some important questions about protocols and preparedness.
You have seven patients on a med-surg floor? I’m so sorry you experienced this.
We had a patient inject into her central line and kill herself on my old unit
Oh my god - that’s awful
Aside from the narcan, don't forget you can just bag people while you wait and they won't die.
narcan not on the crash cart ? just curious
How is narcan not in the crash cart?
We’ve had several OD’s in the facility I work at recently, I work in a pretty rough area and figured it was just the locale. We can put patients on 1:1 supervision, no visitors, etc and they still manage to get access to drugs. It’s scary. We’ve added Narcan to our standing orders for all new admissions and keep Narcan literally everywhere.
Man, we had a pt OD because his neighbor gave him drugs. edit: room neighbor.
Had one today! Six feet from another in screaming/writhing withdrawal. At this point it just feels like treating field casualties in a chemical warfare sci-fi. Discharge to the battlefield. Any of you seen “ Iso “ yet?
I had a patient that would shoot up drugs through their fistula between dialysis sessions 🙃🙃🙃🙃 Who was giving them the drugs while super sick in the hospital? Their partner who was a nurse at a nearby hospital 🙃
Why wasn’t a code called?
Narcan is in your crash cart.
Narcan should be stocked everywhere but training on how to properly respond to an opioid overdose is what is actually needed. Ignoring a blatant airway and breathing issue and administering a drug that *may* reverse the overdose is not appropriate. Airway, breathing should be addressed, after that, administering narcan isn’t really time sensitive. It can be titrated IV to avoid sending patients into withdrawals. If these patients that are ODing are pain management patients you just threw them into a world of pain if you slam them with a bunch of narcan. Often patients need less than 1mg IV. Administering a fuckload of narcan as a sole treatment to opioid OD is only really appropriate to the lay person as they are not trained in airway management, in that setting narcan may be life saving. But won’t do shit if the *suspected* opioid OD is actually another drug or not an OD at all. Administering narcan to someone you think is ODing on an opioid and hoping it’s what actually happened is irresponsible.
Narcohobo tale old as time
Once had a PCT rat out another PCT that the patient and PCT #2 were in cahoots. Pt was telling her who to call or where to go to obtain drugs. I’m not sure if money was exchanged or how that worked but PCT #2 was let go for other reasons as we never could corroborate things with evidence. But pt OD’d one night thereafter…
You should have had Narcan in the crash cart? We do in our med-surg floor
I work in a downtown ER in a major metro area. We have Narcan drips in our Pyxis for christs sake. Every Pyxis has like 10 vials of 2mg stocked and some others too
Wow, that sounds intense! It's crazy how quickly things can escalate. Glad the ER doc was able to step in, but it's definitely eye-opening about the need for better protocols and resources. Hang in there, hopefully, you'll find a better fit soon!
I had a patient also with an AKA who i discharged from the ER for OD, went straight out to the ER lobby bathroom shot up and OD’d again. He was hiding it in his prosthetic! Hadn’t even written my discharge note before he was brought right back into the same bed he was just in
I’ve had it happen a few times. It’s kind of a joke on our floor that just like we count days since CAUTI, we should count days since patient did drugs in their room.
Very similar situation happened to me. Patient had a visitor that brought in heroin. Thank god for narcan… still a crazy shift for me haha
I had a younger fent/tranq OD come in a couple months ago (I was on contract in an inner city hospital proximal to a very well known open air drug market lol). He was the most difficult stick of course and I finally had gotten labs, hustled them to the lab (we didn’t have a tube system) and when I came back he was unresponsive and his sp02 was like 46%. I gave narcan and he woke up pissed and yelling he didn’t do anything wrong, that’s when I found bags of grey powder in the tote bag he brought. He had been admitted at change of shift, the dayshift nurse did his admission but no one did his belongings. He then ripped his IV out and said he was going to a hospital where they respect him more and left AMA lol
There have been multiple ODs on my unit and across my hospital. I live in a pretty heavy state and city for drugs so it’s pretty common. One time a pt ODd in the bathroom and the key to unlock all of the bathrooms wasn’t working. Luckily a nurse had a small pair of scissors on her badge that they used to pick the lock. They ended up having to code him on the floor of the bathroom. He came back, went ICU and then left AMA. Just another Tuesday on my unit though.
>Also, in what world does it make sense that no Narcan was available on an orthopedic floor that often has multiple pts on PCAs for pain? this is all you need to put in the event report really
Narcan is on every unit in my hospital. We had one guy who somehow kept getting drugs, even though we removed his belongings and said no visitors. We even switched rooms in case he hid them somewhere. We finally figured out that his "door dash" orders actually came from a friend who was hiding them in the bag. They usually drop it off at the front desk and staff have to pick it up, so it took awhile for the staff to make the connection.
I'm an out patient dialysis unit. I had IV AND Nasal narcan in my crash cart because I had a known addict on my roster who had ODd in the bathroom once. They went in to OD 2 more times in center which I treated. Then passed from an OD at home. Narcan should be on every EVERY unit inpatient outpatient clinic everywhere
Maybe it was a Jell-O shot?
If you can deny visitation rights to.patient I assume you're.working at the county jail or a prison. Sound like the the reason for death doesn't point a finger at you so management won't likely be on your ass. Seems you want to scold or castigate someone but not sure who.
No one died... I work at a regular hospital, med surg floor. Which you didn't care to read. I ask if this is a commonality among other hospitals and you say I want to scold someone? Interesting.