106 Inappropriate naloxone use in palliative care patients

<h3>Introduction</h3> Naloxone use has been subject to a UK Patient Safety Alert due to the risk of distress and death from inappropriate doses. In palliative care patients and chronic opioid users, total opioid reversal risks acute withdrawal syndrome and a return of pain. In these patients, a titrated reversal of opioids with low-dose naloxone is recommended. This quality improvement project aimed to assess whether naloxone was being used appropriately in the inpatient setting. <h3>Methods</h3> A retrospective analysis of electronic patient records was conducted for patients prescribed and administered naloxone in the trust over two months. Patients were included if they were using prescribed opioids long-term. Data was collected on the reason for naloxone administration and dose administered, respiratory rate, oxygen saturations and level of consciousness. This was triangulated with qualitative information about the patient’s hospital admission. <h3>Results</h3> 13 patients out of 50 who received naloxone met our inclusion criteria. 8 (62%) were administered naloxone inappropriately. The most common reason for naloxone use was reduced consciousness level - 7 (54%) had this documented in their patient notes. 3 patients (23%) died during the same hospital admission, all of whom received inappropriate doses of naloxone, and in one patient this was documented to have caused distress. <h3>Conclusion</h3> Naloxone is commonly used inappropriately in palliative care patients and chronic opioid users in the acute hospital setting, due to use of high-dose naloxone and/or using naloxone when it’s not indicated. This suggests the need for further education of staff prescribing naloxone and scope for a clear clinical guideline. A trust guideline on managing opioid toxicity and using naloxone in this patient cohort has been developed and is in the process of local review before publication. In future, assessment of prescribers’ knowledge will be insightful, and education sessions to disseminate the guideline will be required.