Oct 17, 2016When the University of Massachusetts (UMass) Memorial Medical Center treats patients for an opioid overdose, it often sends them home with naloxone in the form of a nasal spray that they can use to counteract the effects of another overdose, should that occur. The medication, also known by the brand name Narcan, is covered by most insurance plans, but doctors have no way of knowing with certainty how far the medication goes with patients on their way home. In some cases, patients may not be convinced they'll need it, and discard the drug before even leaving the hospital. Because the incidence of opioid overdoses continues to rise, the medical center wishes to determine whether its patients take the naloxone home with them.
Next month, the hospital plans to deploy a real-time location system (RTLS), provided by Visybl, to ascertain whether the medication makes it off the campus. The organization will attach Visybl's Bluetooth Low Energy (BLE) beacons to medication cartons and install CloudNodes (Visybl's BLE gateway devices for capturing beacon transmissions) at the hospital's exit, at a roundabout where cars pass and at the facility's bus stop.
Naloxone blocks or reverses the effect of heroin and other narcotics. It will not permanently resuscitate a patient, but it will reduce the opioid's effects long enough—for approximately 30 minutes—that someone could then call for assistance and get the patient to the hospital in time to save his or her life. Naloxone can be injected into a muscle, under the skin or into a vein, or it can be administered as a nasal spray using a syringe with an atomizer, explains Peter Chai, an assistant professor of emergency medicine at the University of Massachusetts Medical School (UMMS), which is affiliated with the UMass Memorial Medical Center.
Chai leads the naloxone study together with Jeffrey Lai, an emergency medicine physician at the hospital, as well as a medical-toxicology fellow and emergency medicine instructor at UMMS.
The community around the hospital has been stricken with an opioid epidemic in recent years, Chai reports. The frequency of overdoses treated at the facility has been increasing—not only because heroin use has become more prevalent, but also because contaminants in the narcotic have been on the rise as well. When a drug user overdoses, his or her breathing slows down to a dangerously low level and blood vessels constrict. Chai says he sees as many as eight overdoses during the course of a single eight-hour shift.
Massachusetts has established a program to provide naloxone to those at risk of an overdose, but ensuring that the medication is available when required is not easy. The state, as well local governments, "spend millions of dollars to get Narcan into the hands of people at risk of overdosing," he says. However, he notes, just because patients are given the medication to take home with them does not mean they will do so.
Despite money being spent on the naloxone dispersal, the number of overdose deaths is still increasing. Therefore, the study aims to provide a window into what happens after the medication is handed to a patient or to that person's loved one. "The thing we want to solve is, How do we know we're spending the money correctly?," Lai states. "We don't have objective data to know if the program is effective."
To obtain that data, says PV Subramanian, Visybl's founder, the hospital will attach a SlimBeacon—a new Visybl Bluetooth beacon measuring 35 millimeters by 23 millimeters by 2 millimeters (1.4 inches by 0.9 inch by 0.08 inch)—to the inside of each box of naloxone it distributes.
When an overdose patient leaves the hospital, health-care providers will give that patient, or his or her family members, the box of naloxone with the beacon attached. At that time, the patient and family will be told informed that there is a tracking device attached that can be read while they remain on the hospital campus, but not beyond its limits.
As they walk out the door, a Visybl access point installed at that location will capture the beacon's transmission and forward that ID number to the Visybl software residing on a cloud-based server. The tag's ID will not be linked to a specific patient, since the study is not aimed at tracking individuals' movements, but simply the rate at which they retain the medication.
The individual will then proceed to a bus stop, or climb into a car and drive through the roundabout. At either site, another access point will capture the tag ID and forward that information to the software. Physicians will then have a record that the medication has left the campus with that patient. At that point, the hospital will no longer monitor the medication's tag—what the patient does with the naloxone after having left the facility is beyond the project's scope.
To test the system, the hospital temporarily installed a Visybl access point at four different sites: the main exit, the ambulance bays (where patients may also exit), the bus stop and the roundabout.
Hospital personnel carried beacon-tagged medication with them while walking or driving past a Visybl access point, and found that the tags could be easily read at a range of 20 to 30 meters (66 to 98 feet), even when inside a vehicle. They also ascertained that helicopters approaching or leaving the facility did not interfere with transmission, Lai reports.
The goal of the solution is two-fold, Chai says. First, the hospital wants to learn how frequently patients take the medication outside its premises with them. The second goal is to determine how well those patients accept the tracking technology. As part of their treatment, patients are scheduled to return after several weeks; during that follow-up visit, physicians will ask how they felt about the beacon system, and whether they would accept being further tracked, potentially all the way home. Exactly how that extended tracking would be accomplished has not yet been decided, Chai adds. A GPS-based module fitted with some sort of radio (such as one that communicates via a cell-phone tower) could be attached to the medication box, or BLE access points could be installed in some neighborhoods that have a high overdose rate. Emergency responders could also install an app on their smartphones to capture transmissions from any beacon-tagged naloxone within the vicinity, Subramanian says. However, he adds, privacy issues would need to be addressed.
If an extended tracking system were in place, emergency responders could more easily locate an individual experiencing an opioid overdose, by means of the device attached to his or her naloxone medication, assuming it had been brought home. The tracking technology could also provide the hospital with a better sense of where high overdose risks tend to be clustered geographically, which could aid in planning for future emergency responses.
"I want to know two things: what's happening to the naloxone, and how patients using the [tracking] technology accept it," Chai says.
The hospital will provide beacon-tagged naloxone to 30 patients during November and December. After that has been done, it will then determine what its next step will be.
