Addressing Knowledge Deficit around Narcan Administration in Unhoused Youth in the Greater Seattle Area

Introduction For our project we worked with a non profit organization in downtown Seattle that serves houseless youth ages 18-25 with a day center and overnight shelter. Their day center has health clinics, serves lunches, and provides creative activities for the houseless to enjoy. Their overnight shelters are open every night for the houseless, providing 30 beds. The goal of the facility is to end homelessness among youth by partnering with them on their journey towards housing and sustainability. Recently, the center was approved to become a Narcan (naloxone) distribution site. When assessing the needs of the facility we identified the following nursing diagnosis; a knowledge deficit related to the need for Narcan and how to utilize it. Narcan is a drug used as a rescue medication for someone who is experiencing drug overdose. We wanted to encourage the young adults at the shelter to carry Narcan with them and feel inspired to utilize the distribution site. We created two posters, one with information on what Narcan is, how to use it, and why it is important. Our second poster included resources for getting help with drug abuse. We also created a small card for people to carry with Narcan including the steps to take if they ever have to use it. Background A majority of the young adults the facility serves are either experiencing addiction themselves or are surrounded by people who are experiencing addiction. There are more than 40,000 people in King County who are experiencing homelessness (Point in Time Count, 2022). Many of the drugs individuals can purchase off the streets are being mixed with fentanyl since it is cheaper to produce, which is leading to a rise of fentanyl overdose cases (U.S. Department of Health and Human Services, 2023). Fentanyl is being mixed into pills and powders and is unregulated, therefore, it is impossible to know the amount going into each dose (Laced & Lethal, 2021). Drug overdose cases are more common amongst the houseless population, and the addition of fentanyl to street drugs is making the risk of overdose more likely. In King County, fentanyl-related overdose deaths increased by 164% between 2018 and 2020. Fentanyl is up to 50 times stronger than heroin, tasteless, and odorless, making it all the more dangerous (Laced & Lethal, 2021). Naloxone (Narcan) is the only known treatment to counteract the effects of opioid overdose. Narcan works by blocking the effects of opiates on the brain, which in turn also restores breathing (Charles, 2022). Due to the rise in use and overuse of fentanyl, Narcan is becoming more and more important for everyone to carry. The young adults that this facility targets have a higher likelihood of either needing Narcan for themselves, or being around someone who needs to be rescued with it, because they are at risk youth. According to a study done by the Center for Disease Control (CDC), in nearly forty percent of overdose deaths, someone else was present (2023). Having Narcan available allows bystanders to potentially help save a life during an overdose. Narcan can not harm a person who does not need it, only save a person who does. Since Narcan is available to everyone, it is important for houseless individuals to feel comfortable administering and carrying Narcan as it can save their own lives and the lives around them. Activities with Rationale Based on the needs assessment, we identified knowledge deficits surrounding the topics of Narcan use, drug overdose, and drug safety. For our project we created three resources that target a different need of the organization. Our first resource was directed towards the specific population the site serves. For the houseless young adults we created a wallet-sized card that includes condensed information on how to respond during an overdose. We created the small sized card so that it is easy for people to carry it with them. On the card we included signs and symptoms of overdose, how to administer naloxone, and a directive to call 911. In our literature review, we found that fear of arrest and/or prosecution was a barrier to calling for help, therefore, we also emphasized The Good Samaritan Law so that people do not shy away from calling for help. The literature demonstrates that having access to and using Narcan appropriately can help save lives during an overdose (CDC, 2023). The cards address potential knowledge deficits around Narcan for unhoused youth. In addition, the literature demonstrates easy access to information through products like a badge card can improve both process and outcomes. The other two resources we created were educational posters to be hung on the walls of the facility and serve both the staff and clientele. The first poster provided education about overdose signs and symptoms, facts and figures regarding drug use among the houseless population, information on Narcan and how to administer it, the Good Samaritan Law, and resources outside of the facility that can be utilized by people seeking recovery help. The purpose of this poster was to educate clients on how to identify an overdose and take action so they are able to help save lives. Long term opioid abuse and homelessness has a 25% mortality rate (Fine, n.d.) and we aimed to reduce the incidence of drug-overdose related deaths with this poster. The second poster was an infographic that provided a list of resources to their clients such as, addiction help, needle exchange, and detox programs.This poster was meant to condense the resources the site offers to one place. We chose to do this in an appealing, clear, and concise way so that people felt drawn to look at the poster and utilize the resources. All of the elements of our project were meant to reduce overdose mortality within the houseless population, which we identified to be a major issue within our target population. The literature demonstrates that health posters are an effective strategy for transferring knowledge when attempting to reach a wide audience (Hasanica, 2020). Outcomes After meeting with the staff at the facility and deliberating as a group we identified a knowledge deficit requiring narcan administration education, drug overdose education, and drug safety education. The goal of addressing this deficit is to reduce the mortality rate among houseless individuals. An outcome we identified was for clients to be able to recognize the signs and symptoms of opioid overdose. We believe this outcome was achieved by giving our wallet sized card and poster to the site. Another outcome we identified was the need for the population to feel comfortable administering Narcan. Again, giving our poster and wallet sized card on how to administer Narcan to the site allowed us to achieve this outcome. The goal of this was to offer clients easy access to the information, thus reducing a potential barrier, i.e. having to ask for these resources. We achieved this outcome by creating this list in the form of a poster and displaying it in the day center and overnight shelter. Conclusion Our goal was to create a project that would address the knowledge deficit related to Narcan use/opioid overdose/etc as evidenced by our needs assessment, that would continue to be utilized by the facility beyond the project term. During our needs assessment at the site, we identified that the houseless population served is at high risk for drug misuse. Our research led us to discover that many drugs are being laced with fentanyl, a dangerous substance which is leading to an increase in fentanyl overdose and death. Our research also led us to discover that there are often bystanders present when a person overdoses. Therefore, we identified the nursing diagnosis of knowledge deficit. The clients of the site needed more information on drug overdose, drug safety, and Narcan use. The facility recently becoming a Narcan distribution site set up the perfect opportunity for us to create resources that would address these needs. We created a wallet-sized card with step-by-step instructions on what to do when administering Narcan. When clients or employees administer Narcan, the card will be an easy resource for them to reference in the event that they need to give Narcan to someone. The use of cards for rapid access to health literature is evidence-based practice. We also made a poster with overdose signs and symptoms, facts about drug overdose, Narcan administration instructions, and emphasized the good samaritan law. We created this poster to educate clientele on what overdose looks like, how they can help, and how to take action. Health information posters are demonstrated in the literature as an effective educational tool for large audiences. Lastly, we created a simple and colorful poster with helplines and addiction recovery services resources so participants have access, a need identified by the site. All program outcomes were accomplished. Future recommendations are to continue educating the clientele on the importance of carrying Narcan and updated information on drug overdose in the city of Seattle. References Centers for Disease Control and Prevention. (2023, January 25). Lifesaving naloxone. Centers for Disease Control and Prevention. Retrieved February 1, 2023, from https://www.cdc.gov/stopoverdose/naloxone/index.html Charles, Dowd. (2022, July 25). Naloxone: Frequently asked questions. Anne Arundel County Department of Health. Retrieved February 22, 2023, from https://www.aahealth.org/naloxone-frequently-asked-questions/ Fine, D. R., Dickins, K. A., & Adams, L. D. (n.d.). Drug Overdose Mortality Among People Experiencing Homelessness, 2003 to 2018. Jama Network. Retrieved February 1, 2023, from https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2787711 Hasanica, N., Ramic-Catak, A., Mujezinovic, A., Begagic, S., Galijasevic, K., & Oruc, M. (2020). The Effectiveness of Leaflets and Posters as a Health Education Method. Materia socio-medica, 32(2), 135–139. https://doi.org/10.5455/msm.2020.32.135-139 Point in time count. KCRHA. (2022, June 29). Retrieved February 22, 2023, from https://kcrha.org/data-overview/king-county-point-in-time-count/ The risk is real:fentanyl 101. Laced & Lethal ❘ See Why Fentanyl Is So Dangerous. (2021). Retrieved February 1, 2023, from https://www.lacedandlethal.com/fentanyl-101/ U.S. Department of Health and Human Services. (2023, January 9). Fentanyl drugfacts. National Institutes of Health. Retrieved February 1, 2023, from https://nida.nih.gov/publications/drugfacts/fentany

Prospective evaluation of echocardiographic parameters and cardiac biomarkers in healthy dogs eating four custom-formulated diets

IntroductionDiet-associated dilated cardiomyopathy (DCM) has been suspected in breeds that have not been previously noted to have a predisposition to the DCM phenotype. This study hypothesized that over 210 days, dogs fed diets with varying amounts of animal-sourced protein and carbohydrate sources would not be negatively impacted in terms of their cardiac parameters and function.MethodsThirty-two purebred beagles and 33 mixed-breed hounds were randomized into four diet groups and studied for 210 days. The diet groups were as follows: the high-animal-protein grain-free (HAGF) group, the low-animal-protein grain-free (LAGF) group, the high-animal-protein grain-inclusive (HAGI), and the low-animal-protein grain-inclusive (LAGI) group. Cardiac-specific biomarkers, endomyocardial biopsies, and linear and volumetric echocardiographic parameters were evaluated.ResultsThere was a treatment-by-day-by-breed effect observed for the normalized left ventricular internal diameter at end-diastole (p = 0.0387) and for the normalized left ventricular internal diameter at end-systole (p = 0.0178). On day 210, mixed-breed hounds fed the LAGI diet had a smaller normalized left ventricular internal diameter at end-diastole than on day 90. On day 210, beagles fed the LAGF diet had a larger normalized left ventricular internal diameter at end-systole than those fed the LAGI diet. Fractional shortening for beagles in the LAGF group was significantly lower (p = 0.007) than for those in the HAGI and LAGI groups. Cardiac-specific biomarkers and endomyocardial biopsies were not significantly different between breeds, diets, and various time points.DiscussionThis study did not detect the development of cardiac dysfunction throughout the study period through the echocardiographic parameters measured, select cardiac biomarkers, or endomyocardial biopsies. There were noted interactions of treatment, breed, and time; therefore, isolating a diet association was not possible. Future research should further investigate the other factors that may help to identify the variable(s) and possible mechanisms underlying suspected diet-associated DCM in dogs

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