Naloxone Take-Home Kits Program Development Checklist

Naloxone Take-Home Kits: Program Development Checklist

The Louisiana Perinatal Quality Collaborative (LaPQC) thanks you for your participation. The following checklist is meant to provide an overview of the steps needed to launch your maternal take-home naloxone program. Throughout the process, please feel free to reach out to the LaPQC at lapqc@la.gov if you need staff training or technical assistance—we are here to help!

1. Determine process model (distribution recommended vs dispensing vs outpatient pharmacy)
  - See explanation here
2. Adopt or develop your own take-home naloxone distribution guidelines
3. Example of Hospital Naloxone Distribution Policy
4. Key references: Louisiana Board Of Nursing , Louisiana Board Of Pharmacy, Louisiana Department of Health Standards Section
1. Stock donated naloxone kits received from Louisiana Department of Health
  - Store separate from hospital pharmacy inventory (distribution model)
  - Stock in Automatic Dispensing Machines (e.g. Pyxis, Omnicell, MedSelect, etc) on perinatal units for easy access (dispensing model)
1. Create naloxone alerts for at-risk pregnant and postpartum patients
2. Create standing order for take-home naloxone (for distribution model)
  - Standing order example linked here
  - Have physician sign standing order
3. Create order for take-home naloxone in your EMR (for dispensing model)
  - Build Computer Physician Order Entry (CPOE) entry for take-home naloxone kit
  - EPIC example linked here
1. Train nurses, providers, pharmacists and pharmacy technicians
1. Provide printed educational handouts on naloxone and opioid safety
2. Refer patients to video, online and smartphone app resources
  - Naloxone how to videos

For additional resources or information visit: momsplus.us/louisiana or naloxoneproject.com