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!
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Determine process model (distribution recommended vs dispensing vs outpatient pharmacy)
See explanation presentation here
Adopt or develop your own take-home naloxone distribution guidelines
Example of Hospital Naloxone Distribution Policy
Key references: Louisiana Board Of Nursing , Louisiana Board Of Pharmacy, Louisiana
Department of Health Standards Section
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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)
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Create naloxone alerts for at-risk pregnant and postpartum patients
Create standing order for take-home naloxone (for distribution model)
Standing order example linked here
Have physician sign standing order
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
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Train nurses, providers, pharmacists and pharmacy technicians
Powerpoint for key stakeholders
Naloxone Tip Sheet for Providers
Talking to Moms: a 5-step Guide to Successful Conversations
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Provide printed educational handouts on naloxone and opioid safety
A Guide to your Take-Home Naloxone Kit
Naloxone Discharge Handout (English)
Naloxone Discharge Handout (Spanish)
Additional patient resources in English & Spanish
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