Purpose
To combat the continuing rise in opioid-related deaths in Wyoming and potentially save a life, the Teton County Library is participating in the Wyoming Department of Health’s Opioid Overdose Response and NARCAN® for Groups program, which encourages the widespread availability of emergency doses of naloxone nasal spray for administration to individuals suspected of having an opioid overdose.
This document sets forth the policy and procedures required under Wyoming law and the rules and regulations of the Wyoming Department of Health for the Teton County Library to receive and maintain a stock of opiate antagonists1 to ensure ready and appropriate access and facilitate emergency treatment of a person who meets the criteria for a possible opioid overdose by any “Bystander Trained” individual, whether a library staff member, volunteer, or patron.
Background and Wyoming Law
In 2017, Wyoming law expanded who could obtain and administer certain opioid antagonist medications and the legal protections afforded to those administrating these opioid overdose antidotes in emergencies.
Opioid Overdose Response and NARCAN® for Groups Programs
Naloxone is a potentially lifesaving opiate antagonist medication designed to rapidly reverse the effects of an opioid overdose. Given the broad availability in recent years of over-the-counter naloxone nasal spray, the ease of administering a nasal spray, the absence of side effects, and the potential lethal consequences of an untreated opioid overdose, the Wyoming Department of Health’s Opioid Overdose Response and NARCAN® for Groups programs were established to promote the widespread availability of emergency doses of naloxone nasal spray in our communities. NARCAN®2 is a naloxone nasal spray that is available for free through the Department of Health to agencies, businesses, and organizations in Wyoming. The Department of Health encourages the participation of organizations likely to be in a position to help a person suspected of experiencing an opioid overdose.
Wyoming Law
Wyoming’s “Good Samaritan Law” offers certain legal protections to those who voluntarily step in to provide assistance in cases of emergency. Wyoming Statute §1-1-120 states that a person, “who in good faith renders emergency care or assistance without compensation at the place of an emergency or accident, is not liable for any civil damages for acts or omissions in good faith.” Under Wyoming’s Emergency Administration of Medical Treatment Act, a medical practitioner may prescribe, by standing order, an epinephrine auto-injector or an opiate antagonist to entities that may be in a position, in the course of that organizations’ regular business, to assist a person experiencing anaphylaxis or an opiate related drug overdose. Wyo. Statutes §35-4-904(a). A standing order is a prescription issued by a medical provider when there is no prescriber-patient relationship. Wyoming Statute §35-4-902(a)(v).
An entity that is prescribed an epinephrine auto-injector or an opiate antagonist by standing order must establish an anaphylaxis or a drug overdose treatment policy in accordance with Wyoming law and the rules promulgated by the Wyoming Department of Health. Wyoming Statute §35-4-904(b).
The overdose treatment policy must: (1) provide for the designation of individuals to receive training and instructional materials on how to recognize and respond to anaphylaxis or an opiate related drug overdose; (2) ensure that a person to whom epinephrine or an opiate antagonist has been administered receives additional medical care and a medical evaluation; (3) provide for the mandatory reporting to the Department of Health following any event which results in the administration of the epinephrine auto-injector or opiate antagonist; and (4) include any additional requirements in accordance with Wyoming Department of Health Rules and Regulations enacted pursuant to the Emergency Administration of Medical Treatment Act. Wyoming Statute §35-4-904(b).
An entity that establishes the required anaphylaxis or drug overdose treatment policy is immune from civil or criminal liability for any act or omission related to the administration of epinephrine through use of an epinephrine auto- injector or an opiate antagonist resulting in damage or injury. Wyoming Statutes §35-4-906.
Opioid Overdose Treatment and Response Procedures
Designated Individuals for Training
At least one Library staff member will have received the requisite training, as defined and required by the Department of Health, at all times that this program in effect. Should no staff be trained, the program shall be temporarily suspended until such time as a staff member chooses to undertake the training. This training: (1) describes the U.S. opioid overdose epidemic; (2) explains the risk of overdoes from opioid analgesics and heroin; (3) teaches how to recognize an opioid overdose; (4) demonstrates how to respond effectively to an opioid overdose (using animated scenarios, graphic sequences, and narration); and (5) links learners to additional resources, including overdose toolkits and drug treatment finder.
The Director of Library Services shall maintain a list of Library staff and volunteers who have chosen to receive Bystander Training, as defined and approved by the Wyoming Department of Health (currently offered through an online training module at www.getnaloxonenow.org/#gettraining) together with a copy of each individual’s Certificate of Completion.
Supply
The Director of Library Services shall oversee obtaining a valid Wyoming prescription or standing order, as necessary, for the Opiate Antagonist/Naloxone. To order, the Director of Library Services shall oversee the submission of the valid prescription/standing order and completed order form via email to both Truax Patient Services, LLC (bwtruax@truaxpatientservices.com) and the Wyoming Department of Health (bhd.mhsainvoices@wyo.gov) unless otherwise directed by the Wyoming Department of Health. Reorders shall likewise be submitted as the Library’s supply is used or expires.
Storage
The Opiate Antagonist/Naloxone medication will be stored consistent with the manufacturer’s guidelines.
At least one dose of the Opiate Antagonist/Naloxone medication will be clearly and prominently labeled and placed in an unlocked drawer at the front desk of the adult wing at the Jackson Main Branch Library and at the service desk at the Alta Branch Library thereby allowing for ready access in the event of an emergency.
Inventory
The Director of Library Services shall ensure that a log of the Opiate Antagonist /Naloxone medication supply and expiration dates is completed annually.
Emergency Assistance / 911
Emergency Assistance/911 must be called immediately anytime there is an emergency event that prompts the administration of Opiate Antagonist/Naloxone medication to ensure the individual receives additional medical care and a medical evaluation.
Reporting
The Director of Library Services, or their temporary designee, shall be notified immediately of all events that result in the administration of Opiate Antagonist /Naloxone medication.
A Naloxone Report Form shall be completed and submitted to the Wyoming Department of Health electronically within 72 hours of the administration of the Opiate Antagonist/Naloxone medication. The form can be found at Naloxone Administration Survey.
- An Incident Report Form shall be completed for every event that results in administration of Opiate Antagonist/Naloxone medication. Blank Incident Report Forms can be found on the Wyoming Department of Health website or in the Opioid Overdose Treatment and Response Binder at the front desk of the adult wing at the Jackson Main Branch Library and at the service desk at the Alta Branch Library.
- The Incident Report should include, at a minimum: a brief description of the event; the date and time the Opiate Antagonist/Naloxone medication was administered; the name of the individual who administered the Opiate Antagonist/Naloxone medication; the steps taken to ensure the person given the Opiate Antagonist/Naloxone medication received additional medical treatment and a medical evaluation; the date and time that the incident was reported to the Wyoming Department of Health as required; and an acknowledgment via signature of the Director of Library Services.
- The name or other personal information of the individual who was administered the Opiate Antagonist/Naloxone medication should not be disclosed or discussed except as necessary to comply with the legal requirement to ensure the person receives additional medical care and a medical evaluation or as may be required by the Department of Health or other laws.
- If possible the Naloxone Report Form and Incident Report Form should be completed by the individual who administered the Opiate Antagonist/Naloxone medication. Otherwise, a staff member present during the event should complete the report.
- Copies of all Incident Report Forms or other reports related to an event that resulted in administration of Opiate Antagonist/Naloxone medication shall be kept and preserved in a file to allow evaluation of the Library’s Opioid Overdose Treatment and Response Program.
Opioid Overdose Binder
The Library shall maintain an Opioid Overdose Response Binder to ensure that directions for the use of the Opiate Antagonist/Naloxone medication, pertinent contact information, and other information are readily available in the event of an opioid overdose emergency. The Opioid Overdose Response Binder will be labeled clearly and prominently and kept at the front desk of the adult wing at the Jackson Main Branch Library and at the service desk at the Alta Branch Library. The Opioid Overdose Binder contains:
- Opioid Overdose Response Instructions in both English and Spanish
- Incident Report Form
- Naloxone Nasal Spray Inventory Record
- Patient Education Sheet for Naloxone Nasal Spray
- Drug Information Sheet for Naloxone Nasal Spray