PATIENT SAFETY
Spoons are for soup, not medications
To support National Safety Month last June, the CDC developed the two posters shown below-one for healthcare professionals (top) and one for consumers (bottom). The posters reinforce a recently released report by the Choosing Wisely campaign calling for measuring liquid oral medications in mL only, not in teaspoons or tablespoons. The campaign also advocates measuring and administering the medication with the dosing device provided with it, such as a dosing cup or oral syringe marked in mL increments, not a household spoon. As the bottom graphic notes, spoons come in all shapes and sizes and may hold three times more medication than needed.
The Choosing Wisely report, which is written for patients and families, is available at http://www.ismp.org/sc?id=2937.
CARFENTANIL OVERDOSE
Special considerations for emergency responders
An ED nurse reported that staff were caught off guard when a patient who'd overdosed on carfentanil came into the ED recently. Nurses thought a substance resembling gravel on the patient was dirt. Not realizing it was carfentanil, they brushed it off the patient and the bed. They were wearing gloves and no one was harmed.
Carfentanil, a synthetic opioid analogue related to fentaNYL, has been receiving increasing media attention due to its implication in multiple fatal overdoses. Normally used to anesthetize large animals such as elephants, it's 10,000 times more potent than morphine in animals. In addition, it may be laced with heroin or cocaine before it's sold on the street. The National Institute for Occupational Safety and Health recommends that first responders and other caregivers protect themselves from incidental exposure to fentanyl and its analogues by wearing nitrile gloves, eye protection, a P100-rated ventilator, and other personal protective equipment (PPE) when caring for patients experiencing an overdose.
The American College of Medical Toxicology (ACMT) and the American Academy of Clinical Toxicology (AACT) recently released a position statement on preventing incidental exposure to fentanyl and fentanyl analogues such as carfentanil in emergency responders. The statement says that based on available evidence, "incidental dermal absorption is unlikely to cause opioid toxicity." The statement notes that after incidental contact with opioids, some emergency responders have described nonspecific symptoms such as dizziness or feeling as if the body is shutting down or that they're "dying," without displaying objective signs of opioid toxicity such as respiratory depression. "It is very unlikely that small, unintentional skin exposures to tablets or powder would cause significant opioid toxicity, and if toxicity were to occur it would not develop rapidly, allowing time for removal...In the unusual circumstance of significant airborne suspension of powdered opioids, a properly fitted N95 respirator or P100 mask is likely to provide reasonable respiratory protection."
Referencing animal data, the statement also says that "despite anecdotal reports that higher-than-usual doses [of naloxone] may be necessary...standard doses of naloxone should be sufficient to reverse carfentanil."
The AMCT and AACT offer specific guidelines for naloxone administration and first responders' use of PPE based on the belief that "recommendations should be protective of emergency responders, but not result in unnecessary delays in care to patients with time-sensitive conditions."
Read the entire statement at http://www.acmt.net/_Library/Fentanyl_Position/Fentanyl_PPE_Emergency_Responders.