title: Naloxone Triggering the RRT: A Human Antidote?
abstract: At our institution, we observed an increase in opioid-related adverse events after instituting a new pain treatment protocol. To prevent this, we programmed the Omnicell drug dispensing system to page the RRT whenever naloxone was withdrawn on the general wards.
  
  
  
  Retrospective review of a prospectively collected database with a before and after design.
  
  
  
  When comparing the two 12-month periods, there was a decrease in monthly opioid-related cardiac arrests from 0.75 to 0.25 per month (difference = 0.5; 95% CI, 0.04-0.96, P = 0.03) and a nearly significant decrease in code deaths from 0.25 to 0 per month (difference = -0.25; 95% CI, -0.02-0.52, P = 0.07) without a significant decrease in pain satisfaction scores (difference = -2.3; 95% CI, -4.4 to 9.0, P = 0.48) over the study period. There were also decreased RRT interventions from 7.3 to 5.6 per month (difference = -1.7; 95% CI, -0.31 to -3.03, P = 0.02) and decreased inpatient transfers from 2.9 to 1.8 transfers per month (difference = -1.2; 95% CI, -0.38 to -1.96, P = 0.005). When adjusting for inpatient admissions and inpatient days, there was a decrease in opioid-related cardiac arrests from 2.9 to 0.1 per 10,000 admissions (difference = -2.0; 95% CI, -0.2 to -3.8, P = 0.03) and a decrease in cardiac arrests from 0.5 to 0.2 per 10,000 patients (difference = -0.34; 95% CI, -.02 to -0.65, P = 0.04).
  
  
  
  Naloxone-triggered activation of the RRT resulted in reduced opioid-related inpatient cardiac arrests without adversely affecting pain satisfaction scores.
authors.affiliation: From the *Department of Emergency Medicine, and †Director of Critical Care Nursing, University of Florida and Shands Jacksonville Medical Center, Jacksonville, Florida.
authors.forename: Faheem W
authors.initials: FW
authors.lastname: Guirgis
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gerdik
authors.forename: Robert L
authors.initials: RL
authors.lastname: Wears
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Kalynych
authors.forename: Joseph
authors.initials: J
authors.lastname: Sabato
authors.forename: Steven A
authors.initials: SA
authors.lastname: Godwin
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D000931:Antidotes / Q000627:therapeutic use; D006323:Heart Arrest / Q000453:epidemiology / Q000517:prevention & control*; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D009270:Naloxone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D059408:Pain Management; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D000931:Antidotes; D009292:Narcotic Antagonists; D009270:Naloxone