RECOGNIZING AND TREATING AN OPIOID OVERDOSE

SPONSORING ORGANIZATION
MC is a large academic health system with a focus on caring for patients with serious
and complex illnesses. MC operates in five states and cares for more than a million
people a year from all 50 states and 140 countries.
MC Mission: To inspire hope and contribute to health and well-being by providing the
best care to every patient through integrated clinical practice, education and research.
MC Primary Value: The needs of the patients come first.

MC Office of Patient Education (OPE) is the group that will sponsor this project within
the MC system. MC Patient Education supports the MC clinical practice in their efforts
to educate patients across the multi-state Enterprise Health System.

The OPE mission statement: The Office of Patient Education will proactively promote
and facilitate the delivery of high-quality, outcome-based patient education for MC
patents and health care providers throughout the Enterprise.

Vision Statement: Make a difference through patient education.

PROJECT DESCRIPTION
Opioid use in America has reached epidemic proportions. In October of 2016 the
Surgeon General released a report stating that 20 million Americans suffer from a form
of addiction. (U.S. Department of Health and Human Services (HHS), Office of the
Surgeon General, Facing Addiction in America: The Surgeon General’s Spotlight on
Opioids. Washington, DC: HHS, September 2018).
More than 130 people each day die from an opioid-related drug overdose. Drug
overdose is the leading cause of accidental death in the USA and more than 6 out of 10
overdose deaths involved an opioid. (Rudd RA, Seth P, David F, Scholl L. Increases in
Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb
Mortal Wkly Rep. ePub: 16 December 2016. DOI.) Naloxone is a medication that
quickly reverses an opioid overdose and restores breathing in an individual with an
opioid overdose. Research has shown that when naloxone and overdose education are
available to the community, overdose deaths decrease in that community. (U.S.
Department of Health and Human Services (HHS), Office of the Surgeon General,
Facing Addiction in America: The Surgeon General’s Spotlight on Opioids. Washington,
DC: HHS, September 2018). Therefore, making naloxone available to patients with
known access to opioids is a critical step in reducing opioid-related deaths.
MC has the opportunity to provide education to patients their significant others on how
to identify an opioid overdose and safely treat that overdose with the life-saving
administration of naloxone.

AIM
Provide patients and their significant others with the education and skills to identify an
opioid overdose and immediately treat that overdose with naloxone and other
supportive measures. These supportive measures include maintenance of a clear
airway, activating the emergency response system by calling 911, maintaining a safe
environment and recognizing the need for dosage clarification or adjustment following
an overdose.

TARGET AUDIENCE
All MC patients who are dismissed from the inpatient or outpatient setting with an opioid
prescription greater than 90 mme will receive a naloxone (Narcan) prescription. The
target audience is these patients and their available significant others.
DELIVERY OPTIONS

Instruction will be delivered online through the Patient Online Services patient portal.
This delivery option will place the content in a location that is accessible to patients in
their homes, on their devices or in the medical setting. The content will remain on the
portal and be available for repeat viewing and/or to share with significant others.

There is the opportunity to also make this instruction available on the MC Connect
website for Pain Rehabilitation and Addictions patients and families. These groups of
patients would access the content via a password provided by their health care
provider.
INSTRUCTIONAL NEED

According to Rossett (1999) naloxone administration falls into the existing performance
problem category. MC clinicians have noted that patients with access to opioids have a
knowledge and skill deficit related to identifying and safely treating an opioid overdose.

MC has not routinely prescribed naloxone to patients at risk for opioid overdose. A
proposed initiative to provide a naloxone prescription to all patients receiving an opioid
prescription above 90 mme is an effort to prevent the critical incident need of an opioid
overdose death. The difficult part of this instructional need is that the patient is the
individual that Mayo is reliably able to educate on overdose and naloxone. However,
the patient’s significant other is the individual that will actually be in the position to
recognize an overdose, administer the naloxone and take other safety measures. In
order to for patients to effectively receive naloxone treatment, the patient must prepare
the individual or individuals that are most likely to be present at the time of the
overdose. Patients and family members must be aware of the risks associated with
opioids, be able to identify signs of an opioid overdose, know how to administer
naloxone and take the necessary steps following naloxone administration to maintain
safety of the patient and of the person administering the overdose treatment.
LEARNER ANALYSIS

Primary Audience
 Adult chronic pain patients being discharged from the inpatient or outpatient
setting with a naloxone prescription
 Adult acute pain patients being discharged from the inpatient or outpatient
setting with an opioid and a naloxone prescription

Secondary Audience
 Families or significant others of the adult chronic pain patient
 Families or significant others of the adult acute pain patient

General Learner Characteristics

Patients are a very unique audience. While there is typically a wide variation in
expertise and experience on topics associated with their health care and condition, they
do share some unique qualities. Typically, they are being educated on a topic that has
not been a part of their expertise or knowledge base. They are often quite impacted by
pain, stress and fear. Most patients are experiencing some sort of loss that may include
loss of function, independence, the vision of themselves as a healthy person, their
future plans etc. There are relatively common worries such as cost of health care,
caring for family, income interruption etc. All of these factors must be considered as
potential barriers to learning. And, even as patients in the same diagnosis or treatment
or procedure group, there are commonalities in the barriers yet the impact is very
personal. The audience for this project is no exception. Patients with acute or chronic
pain who be prescribed naloxone covers all socioeconomic, diversity, cultural, adult
ages, educational levels and prior experience with pain and pain medications.
 Primary Audience, Patient
o Potentially under the influence of opioid medications or other
substances
o Experiencing acute or chronic pain
 o Experiencing the stress of a disease, condition, diagnosis and/or
treatment
o Assumed low health literacy based on likelihood of pain and stress
o Culturally diverse population
o Diversity of educational background
o Socioeconomic diverse population
o Variable skill or background with medical intervention

 Secondary Audience, Family or Significant Other

o Potential family or relationship stress
o Assume target 6-8th grade literacy level as is standard for health
education due to wide variation of the learners
o Culturally diverse
o Diverse educational background
o Socioeconomic diversity
o Variable skill or background with medical intervention

Entry Characteristics
 There are no consistent or reliable entry characteristics for the primary or
secondary learners. We cannot assume any prior skills related to opioid
overdose or naloxone administration, knowledge of opioids or a specific
attitude toward the topic of opioids or overdose. Due to lack of entry
characteristics in this broad audience this instruction must be designed in a
simple manner with specific, concrete content. The intent is mastery of the
basic, key concepts and important self-management skills rather than on
developing educationally challenging or demanding content. The patient, by
the very nature of the patient role, is assumed to have a low health literacy
level and learning barriers.
 The audience may have some sensitivity related to labels such as addict or to
the stigma of addiction or substance use disorder. Care must be taken to
avoid any judgmental language or labels.