555A
NALOXONE SUPPLY AND ADMINISTRATION FOR OPIOID OVERDOSE
I. PURPOSE
To help address the issue of opioid misuse and to provide a safe environment for all students and staff, Eddyville Blakesburg Fremont Community School District seeks to annually obtain a prescription for and stock in school buildings the opioid overdose reversal medication, naloxone. This medication will be obtained from a licensed healthcare professional, in the name of the school district, for administration by school nurse or personnel trained and authorized to administer to a student or individual who may be experiencing an acute opioid overdose.
II. PROCUREMENT AND MAINTENANCE OF SUPPLY
The superintendent, principal, and/or school nurse will be responsible for the procurement of naloxone. The medication will be acquired through an annual signed standing order of naloxone to students, staff members, or other individuals believed or suspected to be experiencing an opioid overdose on school grounds. The standing order shall include at least the following information: type of naloxone (intranasal and auto-injector), date of issuance, dosage, signature of the prescriber. The supply of such medication shall be maintained in a secure, dark, temperature-controlled location in each school building desired. The school nurse appointed will be responsible for ensuring stock of medication including: expiration date, any visual defects. The school nurse will be responsible for ensuring the district replaces, as soon as reasonably possible, any used, expired, or defective medication.
III. TRAINING
A school nurse or trained personnel may provide or administer the medication if they reasonably and in good faith believe the student or individual is experiencing an opioid overdose. Authorized personnel will be required to provide a procedural skills demonstration to the school nurse demonstrating competency.
IV. INFORMATION/GUIDELINES
Opioid overdose occurs when the amount of opioid in the body is so great the individual becomes unresponsive to stimuli and breathing becomes inadequate. Lack of oxygen affects vital organs, including the heart and brain, leading to unconsciousness, coma, and eventually death. Naloxone is indicated for the reversal of opioid overdose in the presence of respiratory depression or unresponsiveness.
The following may be signs and symptoms of an individual experiencing an opioid-related overdose:
- A history of current narcotic or opioid use or fentanyl patches on skin or needle in the body
- Unresponsive or unconscious individuals
- Not breathing or slow/shallow respirations
- Snoring or gurgling sounds (due to partial upper airway obstruction)
- Blue lips and/or nail beds
- Pinpoint pupils
- Clammy skin
- Vomiting
Note that individuals in cardiac arrest from all causes share many symptoms with someone with a narcotic overdose (unresponsiveness, not breathing, snoring/gurgling sounds, and blue skin/nail beds). If there is no pulse, these individuals are in cardiac arrest and require CPR.
V. EQUIPMENT
Naloxone Hydrochloride and Intranasal Mucosal Atomization Device OR NARCAN® Nasal Spray one-piece pre-assembled nasal device.
VI. PROCEDURE
1. Attempt to rouse and stimulate the student/ patient (rub your knuckles firmly up and down the breastbone).
2. Call 911, get an AED. Have someone call the school nurse and parent(s).
3. If possible, monitor and record respirations, heart rate and blood pressure. Note suspected opiate overdose (as evidenced by pinpoint pupils, depressed mental status, etc.).
4. If available, administer naloxone/ NARCAN®
NALOXONE
a. Remove yellow cap from needleless syringe. Attach the nasal atomizer (applicator) onto the top of the needleless syringe. Remove purple cap from prefilled vial of naloxone. Thread vial into needleless syringe by gently twisting naloxone until you feel it “catch”. DO NOT PUSH VIAL INTO SYRINGE. Expel air.
b. Tilt the person’s head back and spray half of naloxone up one nostril and the other half of naloxone up the other nostril.
IMPORTANT: In an emergency, if you do not have the atomizer, you can squirt the naloxone into the person’s nose as directed without the atomizer.
NARCAN®
c. Peel back the package to remove the device. Hold the device with your thumb on the bottom of the plunger and two fingers on the nozzle. Place and hold the tip of the nozzle in either nostril until your fingers touch the bottom of the patient’s nose. Tilt head back. Press the plunger firmly to release the dose into the patient’s nose.
d. Continue to perform rescue breathing/ CPR as necessary.
5. Start rescue breathing if not breathing or CPR if there is no pulse.
6. Allow 1-3 minutes for medication to work. If no change to the person’s condition after 2-3 minutes, give another dose of naloxone/NARCAN® as in Step 4 above and continue rescue breathing as necessary.
7. Administer CPR if indicated.
8. Stay with the person until medical help arrives. Notify EMS of naloxone administration.
9. Reported administration should be sent to the State Opioid Response (SOR2) helpdesk at sor@idph.iowa.gov as an email and only include the date of administration and the outcome (was the individual able to be revived).
Notes:
- Iowa’s Good Samaritan Law, found under Iowa Code Section 613.17, states “a person, who in good faith renders emergency care or assistance without compensation, shall not be liable for any civil damages for acts or omissions occurring at the place of an emergency or accident or while the person is in transit to or from the emergency or accident or while the person is at or being moved to or from an emergency shelter unless such acts or omissions constitute recklessness or willful and wanton misconduct.” The district, board, authorized personnel or school nurse, and the prescriber shall not be liable for any injury arising from the provision, administration, failure to administer, or assistance in the administration of the opioid antagonist, provided they acted reasonably and in good faith.
- Districts are not required by law to stock and maintain a supply of opioid antagonists. However, if a district wishes to stock and maintain a supply of this medication, the board is required to establish a policy.
- For additional information and resources regarding opioid antagonists, visit https://www.naloxoneiowa.org/
REVIEWED: 11/21/2022 APPROVED: 12/19/2022
REVIEWED: 09/18/2023
