Clinical Pharmacy Specialist Positive Health Clinic Cindy Powers Magrini, PharmD, BCPS.
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Transcript of Clinical Pharmacy Specialist Positive Health Clinic Cindy Powers Magrini, PharmD, BCPS.
Clinical Pharmacy Specialist Positive Health Clinic
Cindy Powers Magrini, PharmD, BCPS
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Naloxone Prescribing at The Positive Health ClinicCindy Powers Magrini, PharmD, BCPSClinical Pharmacy Specialist, Positive Health Clinic (PHC)
July 31, 2012
Introduction to the PHC
• Clinic offers early HIV intervention and treatment using a harm reduction model
• Funded through a federal grant under the Ryan White CARE Act of 1990
• ~750 HIV-positive patients
• 5 physicians
• 2 nurse practitioners
• 3 nurses
• 4 social workers
• 2 medical assistants
• 1 patient advocate
• 1 data analyst
• 1 grant coordinator
• 1 administrative director
• 1 pharmacist
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Cristina Elgins’s Presentation for PHC Staff• Local trends in overdose
• National trends in overdose
• Strategies for preventing opioid fatalities
• Prevention Point Pittsburgh
• Other naloxone prescribers in Pittsburgh
• Project Lazarus
• Legality of prescribing naloxone—Temple University School of Law Memo
• How to treat an overdose situation
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Naloxone Prescribed When: 1. Patient release after emergency medical care involving opioid
OD/intoxication
2. Suspected history of illicit or nonmedical opioid use
3. High-dose opioid prescription (> 50 mg of morphine equivalence/day)
4. Any methadone prescription to opioid naïve patient
Any opioid prescription and …
5. smoking/COPD/emphysema/asthma or other respiratory illness
6. renal dysfunction, hepatic disease
7. known or suspected concurrent alcohol use
8. concurrent benzodiazepine prescription
9. concurrent SSRI or TCA anti-depressant prescription5
Naloxone Prescribed When:
10. Prisoner released from custody
11. Release from opioid detoxification or mandatory abstinence program
12. Voluntary request from patient
13. Patients in methadone or buprenorphine detox/maintenance (for addiction or pain)
14. Patient may have difficulty accessing emergency medical services (distance, remoteness)
15. Other (specify): ____________________________________6
Policy and Procedure Creation
• Intranasal Naloxone Policy
• Controlled Substances Policy
• Any patient with an opioid prescription can be ordered intranasal naloxone by either a nurse or pharmacist per protocol
• Any patient who has a known history of opioid misuse will be offered a prescription for intranasal naloxone after discussion with a prescribing practitioner
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Patient Education
• Patients and family members or friends will watch the intranasal naloxone training video (produced by PPP)
• Staff will review the patient education checklist
• Patients will be given the opportunity to ask questions
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Naloxone Dispensing at PHC
• After the patient has been educated, they will leave the clinic with naloxone in hand that has been dispensed from clinic stock
• The clinic stock will be replaced by placing an order with the clinic’s contract pharmacy
• The order will be adjudicated with the patient’s insurance, if applicable
• The replacement stock will be received at the clinic next day
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Naloxone Dispensing at PHC
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Challenges and Obstacles
• Mechanism for patient education that is sustainable
• Naloxone shortage
• EHR implementation
• Prescribers– Raises uncomfortable issues for prescribers
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Questions
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