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Patient Simulation for Assessment of Layperson Management of Opioid Overdose With Intranasal Naloxone in a Recently Released Prisoner Cohort

Kobayashi, Leo MD; Green, Traci C. PhD, MSc; Bowman, Sarah E. MPH; Ray, Madeline C. BA; McKenzie, Michelle S. MPH; Rich, Josiah D. MD

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare: February 2017 - Volume 12 - Issue 1 - p 22–27
doi: 10.1097/SIH.0000000000000182
Empirical Investigations

Introduction: Investigators applied simulation to an experimental program that educated, trained, and assessed at-risk, volunteering prisoners on opioid overdose (OD) prevention, recognition, and layperson management with intranasal (IN) naloxone.

Methods: Consenting inmates were assessed for OD-related experience and knowledge then exposed on-site to standardized didactics and educational DVD (without simulation). Subjects were provided with IN naloxone kits at time of release and scheduled for postrelease assessment. At follow-up, the subjects were evaluated for their performance of layperson opioid OD resuscitative skills during video-recorded simulations. Two investigators independently scored each subject's resuscitative actions with a 21-item checklist; post hoc video reviews were separately completed to adjudicate subjects' interactions for overall benefit or harm.

Results: One hundred three prisoners completed the baseline assessment and study intervention and then were prescribed IN naloxone kits. One-month follow-up and simulation data were available for 85 subjects (82.5% of trained recruits) who had been released and resided in the community. Subjects' simulation checklist median score was 12.0 (interquartile range, 11.0–15.0) of 21 total indicated actions. Forty-four participants (51.8%) correctly administered naloxone; 16 additional subjects (18.8%) suboptimally administered naloxone. Nonindicated actions, primarily chest compressions, were observed in 49.4% of simulations. Simulated resuscitative actions by 80 subjects (94.1%) were determined post hoc to be beneficial overall for patients overdosing on opioids.

Conclusions: As part of an opioid OD prevention research program for at-risk inmates, investigators applied simulation to 1-month follow-up assessments of knowledge retention and skills acquisition in postrelease participants. Simulation supplemented traditional research tools for investigation of layperson OD management.

From the Department of Emergency Medicine (L.K., T.C.G.), Alpert Medical School of Brown University, Providence, RI; Lifespan Medical Simulation Center (L.K.), Providence, RI; Department of Epidemiology (T.C.G., J.D.R.), School of Public Health, Brown University, Providence; Center for Prisoner Health and Human Rights (T.C.G., S.E.B., M.S.M., J.D.R.), The Miriam Hospital, Providence, RI; Department of Emergency Medicine (S.E.B.), Alpert Medical School of Brown University, Providence, RI; Department of Medicine (M.C.R., M.S.M., J.R.D.), Alpert Medical School of Brown University; Providence, RI.

Reprints: Leo Kobayashi, MD, Lifespan Medical Simulation Center, Suite 106, Coro West Building, 1 Hoppin Street, Providence, RI 02903 (e-mail:

The authors declare no conflict of interest.

Aspects of the simulation sessions and the study intervention discussed within the article were presented as a poster abstract at the 2014 International Meeting on Simulation in Healthcare in San Francisco, CA.

This work was supported by NIH grants R21 DA029201, K24 DA022112 and P30 AI042853. The material discussed is based on work supported by the Departments of Emergency Medicine and Medicine at the Alpert Medical School of Brown University, the Lifespan Medical Simulation Center, and the University Emergency Medicine Foundation. The conclusions, opinions, and recommendations expressed in the manuscript are those of the authors and do not necessarily reflect the views of the supporting entities.

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© 2017 Society for Simulation in Healthcare