176 Use of naloxone in opioid toxicity: a clinical audit

<h3>Background</h3> Opioids are commonly used in symptom-based management in palliative care.¹ Accumulation can result in a toxidrome including, respiratory depression, pinpoint pupils and decreased consciousness.² Prompt recognition and correct reversal with naloxone, an opioid antagonist, is vital. This study aimed to review the use of naloxone in opioid toxicity in Oxford University Hospitals. <h3>Methods</h3> Retrospective data of patients managed for opioid toxicity over a 12-month period in 2022.23 was collated. A convenience sample of 59 patients (18%) was selected. A data collection form was developed, and independently tested and updated by the authors. The electronic patient records were reviewed, with data collected, anonymised and stored on secure NHS drives. Data was reviewed and analysed by the authors. Ethics permission was not sought as the data looked at routine clinical practice. <h3>Results</h3> The indication of naloxone use in 56% was drowsiness, in 25% suspected overdose, in 12% hypoxia and in 7% a respiratory rate of less than 8. 1 patient was given naloxone despite not being on opioids. Doses administered ranged from 40mcg to 1600mcg, with 52.5% receiving 1 dose, 15% receiving 2 doses, 22% receiving 3 doses and 12% commenced on a continuous infusion. 2 patients were given multiple doses of naloxone over 24 hours apart. 12% of patients were known to palliative care and 12% of patients died during admission. <h3>Conclusion</h3> Data collectors agreed with the decision to give naloxone in only 66% of patients, highlighting the need for improved education on recognising opioid toxicity and correctly prescribing and administering naloxone. Key learning points included poor history taking of opioid use, inadequate assessment for key features of opioid toxicity and the inappropriate use of naloxone to diagnose dying. We have started to address these problems with developing new local guidelines and educational resources to support safe practice going forward. <h3>References</h3> Pickard J, McDonald E, Hindmarsh J. Opioid use in palliative care: selection, initiation and optimisation. [online] <i>The Pharmaceutical Journal</i> 2020. Available at: https://pharmaceutical-journal.com/article/ld/opioid-use-in-palliative-care-selection-initiation-and-optimisation. Ostwal SP, Salins N, Deodhar J. Reversal of Opioid-Induced Toxicity. <i>Indian Journal of Palliative Care</i> 2017;<b>23</b>(4):484–486. doi:https://doi.org/10.4103/IJPC.IJPC_117_17.