Pediatric Community

Hello All,

I work within a free-standing pediatric hospital system. While we do have an Adult Code Blue policy, we've identified an area where we could improve our response.

We have naloxone in our code carts; however, it is a concentration designed for IM/IV/IO administration, not nasal, though it can be administered nasally.

We've recently had a few adults go down with overdose events in public areas (think bathrooms, the cafeteria, or their kid's hospital room) that required naloxone. There are police liaisons at some of my facilities and not others, so in some facilities, the police carry the nasal atomizer and administer naloxone.

This sparked discussion about whether we can/should have naloxone in a nasal atomizer format available and ready for use, like we do with AEDs. However, as a pediatric facility, there has been pushback from our risk and legal teams.

Do any free-standing pediatric facilities have a naloxone process for adult, non-patient overdose events?

Do you have it accessible in places like AEDs? I've heard of places like libraries having naloxone available in areas that are freely accessible.

Do you keep it in your code cart?

I'm in MN if that factors into anything!

Thank you!

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Elizabeth Leming BSN;BA;CCRN
Clinical Practice Specialist
Children's Minnesota
St Paul MN
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Hi Elizabeth! I am in a pediatric emergency department in a dedicated children's hospital that is connected to our adult hospital counterpart. If patient visitors or random adults happen to require naloxone while in the emergency department, we register them (either by their demographics or as an unknown patient if we can't get any information), administer any lifesaving or stabilizing treatment per EMTALA, then transfer to our Adult ER. We keep naloxone in our code carts, but also have a pharmacy in the ER or can override it from our Omnicell, then can draw up and administer with a mucosal atomizer (which we keep stocked in the medication room and also in our IV carts on the unit). If they require naloxone in any area outside of the emergency department, they are brought to the nearest emergency department (the Adult ER is in a separate but connected building), and then the same applies. I imagine that it's harder when it's not happening in your emergency department where you can just register them, pull the medication, and give it.

I'm surprised that risk and legal don't consider EMTALA, as well as the fact that pediatric patients may need intranasal naloxone, not just from presenting with acute ingestions (whether accidental or intentional) or as a reversal agent if you are doing procedural sedations or giving narcotics as part of patient care.

Are there any medications that you bring to an emergency response alert for a visitor if they are not in the ER? Who responds to these alerts?

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Tara Doherty, MSN, RN, CPEN, TCRN
Pediatric Emergency Nurse
NewYork-Presbyterian/Morgan Stanley Children's Hospital
New York, NY
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