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​Nursing pathway research saving lives

Tuesday 20 July 2021

A research project supported by the PA Research Foundation is empowering nurses to save lives of patients with opioid poisoning.

The project entitled Assessing the implementation of a nursing care pathway for opioid poisoned patients in the ED; a before and after study addresses a growing issue in emergency care and is being led by the Director of the PA Hospital's (PAH) Clinical Toxicology Unit, emergency physician Dr Katherine Isoardi.

Director of the PA Hospital's (PAH) Clinical Toxicology Unit, emergency physician Dr Katherine Isoardi

With opioid poisoning now overtaking car accidents as a cause of death in Australia, Dr Isoardi's project guides nursing staff on when to give the drug naloxone to opioid poisoned patients to reverse the toxic sedative effects of opioids which can cause death, saving lives and freeing up resources as a result.

"The pathway itself is for the nursing staff managing opioid poisoned patients in the resuscitation bay. It guides how often and how frequently you need to do observations and then if the patient meets certain triggers, which is a respiratory rate of less than 10 or low oxygen saturation, nursing staff give naloxone through the vein every three minutes." she said.

"They manage the patient without necessarily needing a doctor in the room to make it happen, they then continue to observe them closely and follow the pathway as they manage the opioid overdose independently.

"It's increasing the scope of the nursing staff and how they manage patients with opioid poisoning."

Passionate about the treatment and management of opioid poisoning, which can include drugs such as heroin, morphine, fentanyl, oxycodone, and codeine, Dr Isoardi is conducting the project as part of her PhD in the subject and said the PAH's nursing staff have embraced the use of the pathway so far and it is already showing positive results.

"There have been cases of misadventure following people presenting to hospital with opioid poisoning where they have suffered avoidable adverse events such as aspiration pneumonitis, and rarely even death. So, we think this nursing pathway will improve patient management and hopefully this will translate to improved patient outcomes." Dr Isoardi said.

"The nurses enjoy having an increased scope and being able to be a bit more independent. It is always good to have that expertise for them also. Certainly, our nursing staff are incredibly capable because we are the only toxicology unit in the state that runs 24/7. They already have a great skill set in managing toxicology patients, but I think they enjoy the independence of having these extra skills.

"Hopefully if we can demonstrate that this pathway is effective and well received, we can expand this project at least across our health service and potentially further with a view to better managing opioid poisoned patients.

"The study has been going for a few months but with all of the covid craziness we've actually had a slight decrease in our opioid presentations which is a good thing, but what it definitely has been showing is that the pathway is working,"

"It's showing that there is less instances of people who are showing respiratory repression or that are meeting criteria for opioid reversal that aren't receiving naloxone, so people are giving it more and more appropriately."

With PAH emergency staff focused on the best outcomes possible for their patients, Dr Isoardi said she was thankful to the PA Research Foundation and its donors for supporting studies in emergency medicine which will ultimately help them continue to care for more patients and save more lives.

"There has been a lot of clinical work done in emergency medicine and in more recent years there has been a move into the research sphere, certainly within our department because we've always been so focused on service delivery," she said.

"I think that it's really wonderful that people have donated to the Foundation to let us allocate some time and resources towards research.

"We are a big department, and we help a lot of patients, and we can potentially do quite a lot of good practice changing research which is the idea, certainly within the toxicology unit which is embedded within the emergency department. This foundation grant is a really wonderful opportunity."

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