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VHA Rapid Naloxone

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In September 2018, the Veteran’s Health Administration (VHA) launched a Rapid Naloxone Initiative that aims to reduce opioid overdose deaths by increasing the rapid availability of Naloxone. This is done via three practice elements: 1) Opioid Overdose Education and Naloxone Distribution (OEND) to VHA patients who are at-risk for opioid overdose, 2) VA Police carry Naloxone, and 3) Automated External Defibrillator (AED) Cabinets contain Naloxone.

This innovation is scaling widely with the support of national stakeholders. See more scaling innovations.

Origin:

March 2015, Jamaica Plain VA Medical Center

Adoptions:

100 successful, 50 in-progress, 4 unsuccessful

Awards and Recognition:

Diffusion of Excellence Promising Practice, Gears of Government Winner, VHA Shark Tank Winner

Partners:

Diffusion of Excellence, Office of Primary Care

Tags:

Pharmacy
Contact Team

Overview

Problem

The country is in the midst of an opioid crisis and Veterans are twice as likely to die from accidental overdose compared to non-Veterans. Opioid overdose mortality is preventable with timely and sufficient administration of naloxone, a safe and effective opioid overdose reversal medication that has FDA-approved layperson routes of administration (e.g., nasa ... See more

Solution

the VHA Rapid Naloxone Initiative and it aims to reduce opioid overdose deaths among Veterans by increasing the rapid availability of naloxone to VHA patients and staff via three practice elements: (1) Opioid Overdose Education and Naloxone Distribution (OEND) to VHA patients at-risk for opioid overdose, (2) VA Police Naloxone, and (3) AED Cabinet Naloxone.

Images

AED cabinet with naloxone. Note red "N" and seal

Pouch that attaches to VA Police gear

Links

Results

VA Boston’s implementation of all three elements has resulted in 134 reported opioid overdose reversals with naloxone to date (OEND=119, VA Police=13, AED Cabinets=2).

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

Statuses

AK: Colonel Mary Louise Rasmuson Campus of the Alaska VA Healthcare System (Anchorage) AR: Eugene J. Towbin Healthcare Center (North Little Rock) AR: Fayetteville VA Medical Center (Fayetteville, Arkansas)
  • Started adoption on 09/2019.
AR: John L. McClellan Memorial Veterans' Hospital (Little Rock, Arkansas) AZ: Carl T. Hayden Veterans' Administration Medical Center (Phoenix, Arizona) AZ: Tucson VA Medical Center (Tucson) CA: Jennifer Moreno Department of Veterans Affairs Medical Center (San Diego, California) CA: Loma Linda VA Clinic (Loma Linda Redlands) CT: Newington VA Clinic (Newington) CT: West Haven VA Medical Center (West Haven) DC: Washington VA Medical Center (Washington, District of Columbia) FL: Bruce W. Carter Department of Veterans Affairs Medical Center (Miami) FL: C.W. Bill Young Department of Veterans Affairs Medical Center (Bay Pines) FL: Orlando VA Medical Center (Orlando) GA: Carl Vinson Veterans' Administration Medical Center (Dublin) GA: Charlie Norwood Department of Veterans Affairs Medical Center (Augusta Downtown) HI: Spark M. Matsunaga Department of Veterans Affairs Medical Center (Honolulu) IA: Des Moines VA Medical Center (Des Moines, Iowa) ID: Boise VA Medical Center (Boise) IL: Captain James A. Lovell Federal Health Care Center (North Chicago) IL: Danville VA Medical Center (Danville, Illinois) IL: Edward Hines Junior Hospital (Hines) KS: Colmery-O'Neil Veterans' Administration Medical Center (Topeka) KS: Dwight D. Eisenhower Department of Veterans Affairs Medical Center (Leavenworth) KS: Robert J. Dole Department of Veterans Affairs Medical and Regional Office Center (Wichita) KY: Franklin R. Sousley Campus (Lexington Leestown)
  • Started adoption on 03/2019.
KY: Robley Rex Department of Veterans Affairs Medical Center (Louisville) KY: Troy Bowling Campus (Lexington Cooper)
  • Started adoption on 03/2019.
LA: Alexandria VA Medical Center (Alexandria, Louisiana) MA: Brockton VA Medical Center (Brockton) MA: Edith Nourse Rogers Memorial Veterans' Hospital (Bedford) MA: Edward P. Boland Department of Veterans Affairs Medical Center (Central Western Massachusetts)
  • Started adoption on 06/2017.
MA: Jamaica Plain VA Medical Center (Jamaica Plain) MA: West Roxbury VA Medical Center (West Roxbury) MD: Baltimore VA Medical Center (Baltimore) ME: Togus VA Medical Center (Togus) MI: Aleda E. Lutz Department of Veterans Affairs Medical Center (Saginaw, Michigan) MI: Battle Creek VA Medical Center (Battle Creek) MI: John D. Dingell Department of Veterans Affairs Medical Center (Detroit) MI: Lieutenant Colonel Charles S. Kettles VA Medical Center (Ann Arbor) MI: Oscar G. Johnson Department of Veterans Affairs Medical Facility (Iron Mountain) MN: St. Cloud VA Medical Center (St. Cloud) MO: John J. Pershing Veterans' Administration Medical Center (Poplar Bluff)
  • Started adoption on 09/2019.
MS: Biloxi VA Medical Center (Biloxi) MT: Fort Harrison VA Medical Center (Fort Harrison) MT: Miles City VA Community Living Center (Miles City CLC)
  • Started adoption on 12/2018.
NC: Charles George Department of Veterans Affairs Medical Center (Asheville) NC: Fayetteville VA Medical Center (Fayetteville, North Carolina) ND: Fargo VA Medical Center (Fargo) NH: Manchester VA Medical Center (Manchester) NJ: East Orange VA Medical Center (East Orange) NJ: Lyons VA Medical Center (Lyons) NV: North Las Vegas VA Medical Center (North Las Vegas)
  • Started adoption on 01/2019.
NY: Batavia VA Medical Center (Batavia) NY: Bath VA Medical Center (Bath) NY: Brooklyn VA Medical Center (Brooklyn) NY: Buffalo VA Medical Center (Buffalo, New York) NY: Canandaigua VA Medical Center (Canandaigua) NY: Castle Point VA Medical Center (Castle Point) NY: Franklin Delano Roosevelt Hospital (Montrose, New York)
  • Started adoption on 05/2017.
NY: Margaret Cochran Corbin VA Campus (Manhattan) NY: Northport VA Medical Center (Northport) NY: Samuel S. Stratton Department of Veterans Affairs Medical Center (Albany, New York) NY: Syracuse VA Medical Center (Syracuse) OH: Chalmers P. Wylie Veterans Outpatient Clinic (Columbus, Ohio) OH: Louis Stokes Cleveland Department of Veterans Affairs Medical Center (Cleveland, Ohio) OK: Jack C. Montgomery Department of Veterans Affairs Medical Center (Muskogee, Oklahoma) OK: Oklahoma City VA Medical Center (Oklahoma City) OR: Portland VA Medical Center (Portland, Oregon) OR: Roseburg VA Medical Center (Roseburg) OR: White City VA Medical Center (White City)
  • Started adoption on 09/2017.
PA: Coatesville VA Medical Center (Coatesville) PA: H. John Heinz III Department of Veterans Affairs Medical Center (Heinz)
  • Started adoption on 02/2019.
PA: James E. Van Zandt Veterans' Administration Medical Center (Altoona) PA: Pittsburgh VA Medical Center-University Drive (Pittsburgh) PA: Wilkes-Barre VA Medical Center (Wilkes-Barre) PR: San Juan VA Medical Center (San Juan) RI: Providence VA Medical Center (Providence) SD: Royal C. Johnson Veterans' Memorial Hospital (Sioux Falls) TN: Alvin C. York Veterans' Administration Medical Center (Murfreesboro) TN: James H. Quillen Department of Veterans Affairs Medical Center (Mountain Home, Tennessee) TN: Nashville VA Medical Center (Nashville) TX: Olin E. Teague Veterans' Center (Temple) UT: George E. Wahlen Department of Veterans Affairs Medical Center (Salt Lake City)
  • Started adoption on 01/2019.
VA: Hampton VA Medical Center (Hampton) VA: Richmond VA Medical Center (Richmond, Virginia) VA: Salem VA Medical Center (Salem, Virginia) VT: White River Junction VA Medical Center (White River Junction) WA: American Lake VA Medical Center (American Lake) WA: Jonathan M. Wainwright Memorial VA Medical Center (Walla Walla) WA: Mann-Grandstaff Department of Veterans Affairs Medical Center (Spokane, Washington) WA: Seattle VA Medical Center (Seattle) WI: Clement J. Zablocki Veterans' Administration Medical Center (Milwaukee, Wisconsin) WI: Tomah VA Medical Center (Tomah) WI: William S. Middleton Memorial Veterans' Hospital (Madison) WV: Beckley VA Medical Center (Beckley) WV: Hershel "Woody" Williams VA Medical Center (Huntington, West Virginia) WV: Louis A. Johnson Veterans' Administration Medical Center (Clarksburg) WV: Martinsburg VA Medical Center (Martinsburg) WY: Sheridan VA Medical Center (Sheridan)

AL: Central Alabama VA Medical Center-Montgomery (Montgomery)
  • Started adoption on 09/2019.
AL: Central Alabama VA Medical Center-Tuskegee (Tuskegee)
  • Started adoption on 09/2019.
AL: Tuscaloosa VA Medical Center (Tuscaloosa)
  • Started adoption on 09/2019.
AZ: Bob Stump Department of Veterans Affairs Medical Center (Prescott)
  • Started adoption on 03/2019.
CA: Palo Alto VA Medical Center-Livermore (Palo Alto Livermore)
  • Started adoption on 09/2019.
CA: Palo Alto VA Medical Center-Menlo Park (Palo Alto Menlo Park)
  • Started adoption on 09/2019.
CA: Sacramento VA Medical Center (Sacramento)
  • Started adoption on 09/2019.
CA: San Francisco VA Medical Center (San Francisco)
  • Started adoption on 09/2019.
CA: Tibor Rubin VA Medical Center (Long Beach)
  • Started adoption on 03/2019.
CA: West Los Angeles VA Medical Center (West Los Angeles)
  • Started adoption on 09/2019.
CO: Denver VA Medical Center (Denver)
  • Started adoption on 09/2019.
CO: Grand Junction VA Medical Center (Grand Junction, Colorado)
  • Started adoption on 09/2019.
DE: Wilmington VA Medical Center (Wilmington, Delaware)
  • Started adoption on 09/2019.
FL: James A. Haley Veterans' Hospital (Tampa, Florida)
  • Started adoption on 09/2019.
FL: Lake City VA Medical Center (Lake City, Florida)
  • Started adoption on 09/2019.
FL: West Palm Beach VA Medical Center (West Palm Beach)
  • Started adoption on 09/2019.
GA: Joseph Maxwell Cleland Atlanta VA Medical Center (Atlanta, Georgia)
  • Started adoption on 04/2019.
IA: Iowa City VA Medical Center (Iowa City, Iowa)
  • Started adoption on 03/2019.
IL: Jesse Brown Department of Veterans Affairs Medical Center (Chicago, Illinois)
  • Started adoption on 12/2018.
IL: Marion VA Medical Center (Marion, Illinois)
  • Started adoption on 09/2019.
IN: Fort Wayne VA Medical Center (Fort Wayne)
  • Started adoption on 09/2019.
IN: Richard L. Roudebush Veterans' Administration Medical Center (Indianapolis, Indiana)
  • Started adoption on 09/2019.
LA: New Orleans VA Medical Center (New Orleans)
  • Started adoption on 09/2019.
LA: Overton Brooks Veterans' Administration Medical Center (Shreveport)
  • Started adoption on 09/2019.
MN: Minneapolis VA Medical Center (Minneapolis, Minnesota)
  • Started adoption on 03/2019.
MO: Harry S. Truman Memorial Veterans' Hospital (Columbia, Missouri)
  • Started adoption on 09/2019.
MO: Kansas City VA Medical Center (Kansas City, Missouri)
  • Started adoption on 09/2019.
MO: St. Louis VA Medical Center-Jefferson Barracks (St. Louis Jefferson Barracks)
  • Started adoption on 09/2019.
NC: Durham VA Medical Center (Durham)
  • Started adoption on 09/2019.
NC: W.G. (Bill) Hefner Salisbury Department of Veterans Affairs Medical Center (Salisbury)
  • Started adoption on 03/2019.
NE: Grand Island VA Medical Center (Grand Island)
  • Started adoption on 09/2019.
NE: Omaha VA Medical Center (Omaha, Nebraska)
  • Started adoption on 09/2019.
NM: Raymond G. Murphy Department of Veterans Affairs Medical Center (Albuquerque)
  • Started adoption on 09/2019.
NV: Ioannis A. Lougaris Veterans' Administration Medical Center (Reno)
  • Started adoption on 09/2019.
OH: Chillicothe VA Medical Center (Chillicothe)
  • Started adoption on 09/2019.
OH: Cincinnati VA Medical Center (Cincinnati, Ohio)
  • Started adoption on 09/2019.
OH: Dayton VA Medical Center (Dayton)
  • Started adoption on 09/2019.
PA: Butler VA Medical Center (Butler New Castle Road)
  • Started adoption on 09/2019.
PA: Erie VA Medical Center (Erie)
  • Started adoption on 09/2019.
PA: Lebanon VA Medical Center (Lebanon)
  • Started adoption on 09/2019.
SC: Ralph H. Johnson Department of Veterans Affairs Medical Center (Charleston, South Carolina)
  • Started adoption on 09/2019.
SC: Wm. Jennings Bryan Dorn Department of Veterans Affairs Medical Center (Columbia, South Carolina)
  • Started adoption on 09/2019.
SD: Fort Meade VA Medical Center (Fort Meade, South Dakota)
  • Started adoption on 09/2019.
SD: Hot Springs VA Medical Center (Hot Springs, South Dakota)
  • Started adoption on 03/2019.
TN: Lt. Col. Luke Weathers, Jr. VA Medical Center (Memphis)
  • Started adoption on 09/2019.
TX: Audie L. Murphy Memorial Veterans' Hospital (San Antonio, Texas)
  • Started adoption on 09/2019.
TX: Dallas VA Medical Center (Dallas)
  • Started adoption on 09/2019.
TX: Kerrville VA Medical Center (Kerrville)
  • Started adoption on 09/2019.
TX: Sam Rayburn Memorial Veterans Center (Bonham)
  • Started adoption on 09/2019.
WY: Cheyenne VA Medical Center (Cheyenne)
  • Started adoption on 03/2019.

CA: Fresno VA Medical Center (Fresno) TX: George H. O'Brien, Jr., Department of Veterans Affairs Medical Center (Big Spring) TX: Michael E. DeBakey Department of Veterans Affairs Medical Center (Houston) TX: Thomas E. Creek Department of Veterans Affairs Medical Center (Amarillo)

Multimedia

Images

Pam Bellino

Implementation

Timeline

  • Month 1
    Identify a Facility Champion / garner support from stakeholders
  • Month 2 and 3
    Develop a local policy and obtain approval / AED cabinet identification / AED cabinet physical set up
  • Month 4
    Increase staff awareness of program / staff training and implementation of program
  • Ongoing
    Monitoring and program evaluation

Core Resources

Files

Links

Risks and mitigations

Risk Mitigation
Police officers may not want to carry Naloxone. Compliance is voluntary.
Staff may not see a need to equip AED cabinets with Naloxone. Enthusiastic practice champion can teach staff and provide motivation.

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

Email

Email with questions about this innovation.

About

Origin story

It was at least 10 minutes from the time a housekeeper pushed into a bathroom on the Brockton VA campus and found a man on the floor to the time paramedics arrived. They used Naloxone, common brand name Narcan, to reverse the man's opioid overdose. Brain damage can begin after just five minutes without oxygen. Pam Bellino, patient safety manager for VA Bo ... It was at least 10 minutes from the time a housekeeper pushed into a bathroom on the Brockton VA campus and found a man on the floor to the time paramedics arrived. They used Naloxone, common brand name Narcan, to reverse the man's opioid overdose. Brain damage can begin after just five minutes without oxygen. Pam Bellino, patient safety manager for VA Boston, which includes Brockton, read the incident report back in December 2015 with alarm. "That was the tipping point for us to say, 'We need to get this naloxone immediately available, without locking it up,' " she said. The easiest way to make Naloxone immediately available, Bellino reasoned, would be to add the drug to AED cabinets — the metal boxes on the walls of VA cafeterias, gyms, warehouses, clinic waiting rooms, and some rehab housing. https://www.wbur.org/commonhealth/2018/09/19/boston-va-narcan-aed-boxes

Original team

Dr. Elizabeth Oliva

OEND National Coordinator

Pam Bellino

Patient Safety Manager

Mary Burkhardt

Pharmacy Executive National Center for Patient Safety

Dr. Jennifer Burden

Deputy Director, MH RRTP

Carl McCoy

Diffusion Specialist

Search tags

Pharmacy