Just as reporting adverse events helps improve patient safety, reporting workplace incidents that have harmed or had the potential to harm employees can inspire change to protect healthcare staff as well as patients and visitors.
Even the slightest contact with synthetic opioids such as fentanyl or carfentanil (which is 100 times more potent than fentanyl), such as touching a patient with the substance on them or breathing in trace amounts, can lethally poison unprotected healthcare workers. This is what happened to three emergency department nurses at one medical center in August 2017, when they were exposed to fentanyl while cleaning the room in which an opioid patient had been treated. All three nurses had to be resuscitated with naloxone, a medication which rapidly reverses an opioid overdose. Following this incident, and in light of the increasing opioid epidemic, ER leadership took immediate action to prevent it from reoccurring.
Although personal protective equipment (PPE)—hair bonnets, masks with eye protection, plastic gowns, gloves, and shoe covers—was readily available in the ER, a cabinet was dedicated to store all PPE in the department centrally, which is always fully stocked. All staff members (providers, nurses, and ancillary workers) who may come in contact with an overdose patient were educated about the location and purpose of this cabinet and received resources about preventing occupational exposure to fentanyl and carfentanil. An annual hospital emergency response training exercise was also established to practice decontamination procedures to protect staff and patients from possible exposure to an opioid before contaminated patients arrive in the ER for treatment.
