Increasing uptake of naloxone in East Sussex
Peter Hawley, one of Change Grow Live’s naloxone champions, describes how he doubled the uptake of the overdose reversal drug naloxone, in his East Sussex service.
I am currently a recovery worker for the East Sussex Drug and Alcohol Recovery Service (STAR) lone working in rural settings, where 30% of our service users are based. The other 70% are spread over two seaside towns 20 to 25 miles away from my hubs, providing treatment from two main services. I care-coordinate approximately 80-90 people at any one time working closely with GPs. I also promote naloxone over the whole county, a drug that can be used to reverse the effects of an opioid overdose.
When I got the role, I came across the Change Grow Live Naloxone League Table, which showed the ranking of services that offer and dispense naloxone. I saw that East Sussex was 18th out of 60 in the league, so there was room for improvement. I used the table as an indicator of our performance and as a motivational tool for the team.
Developing tools and training to promote naloxone
My first step was to carry out a naloxone audit across the county. Some of our staff were regularly giving out kits - but some of them weren’t. It depended on who the key worker was, or if a service user’s risk of overdose was deemed to be high. It was a pick and mix approach.
With buy-in from the team, we designed a Standard Operating Procedure flowchart which covered how and when to dispense naloxone and listed all the service user touchpoints. This covered the initial point of contact and review, medical assessments and triage and featured all additional elements such as inpatient detox and prison release. We also added in checkpoints to review if a service user’s kit had expired, or gone missing, or had been used.
Alongside this I delivered bitesize training and goal setting for the team, to help bring up the distribution and uptake percentages for each of the Hubs. One Hub did better than the other, so we played them off against each other and had a bit of a laugh about it and it worked. I trained staff in a range of naloxone-related competencies which covered harm reduction, how to administer naloxone, how to identify the signs of overdose, how to carry out CPR, how to record appropriate data and manage stock.
90% of service users are now offered naloxone
Within a few months, our service had climbed from 18th place in the Naloxone League Table to the very top. I had trained 100 staff and 90% of our service users had now been offered naloxone. The take-up of naloxone had also increased, rising from 43% to just under 90%.
Now, staff are all talking about naloxone and clamouring to get on the bandwagon and get trained. We’ve made it a positive thing. If you’ve not got the motivation to carry on and implement something and it’s not made fun, then it becomes another task on top of all the others you’ve got.
Feedback from service users
Service users are happy about our progress too. In the conversations we have with the people who receive our kits, they say they are very grateful to have been given a life-saving tool. I heard that a couple of people used it on the day they first received it. They used it to save two people’s lives and came back to the Hub the next day to collect another kit.
The word has got around. In Hastings, there was an overdose situation near to the Hub and a person who had been trained in overdose awareness and witnessed the overdose incident didn’t have the kit on him, so ran in an asked a member of staff to help and administer naloxone in the street. This potentially saved someone’s life. Quite a lot of our service users could deliver the training better than me now.
Since then I’ve trained a cohort of Change Grow Live’s doctors on the East Sussex Standard Operating Procure to help expand the dispensing of naloxone. I’ve also delivered training to the National Probation Approved Premises Leadership Team. They are now working with Change Grow Live nationally to train all approved premises staff in naloxone administration and to provide everyone with a kit.
I delivered naloxone training to the East Sussex safer communities board and they requested that I set up a multi-agency working group involving members from the police service, police and crime commission, NHS clinical commissioning group (CCG), PHE and Change Grow Live.
The next step is to work further with these partner agencies in East Sussex on the multi-agency naloxone working group. As we understand it, this will be the first of its kind in the UK with the focus on widening the use and dispense of naloxone via other services to potentially save more lives!