An emergency department visit for an opioid-related event, or for any patient at elevated overdose risk, is a practical moment to put naloxone and the knowledge to use it into the right hands before discharge. The nursing role here is concrete: screen, teach, document, and confirm the patient and the people around them can act if breathing stops.
Identify who should leave with naloxone
Take-home naloxone is not reserved for patients who arrived in overdose. Defer to your facility's screening protocol, but the populations that benefit are broad. The CDC describes naloxone as the medication that reverses opioid overdose and notes it should be available to people using illicit opioids such as heroin or fentanyl, people prescribed higher-dose opioids, and people who combine opioids with benzodiazepines.
In practice, the ED nurse is often the one who flags eligibility during triage or the discharge workup. A scoping review of ED naloxone distribution programs found that screening commonly targets patients with opioid-related visits or a known substance-use history, and that nurses frequently dispense the kit after a physician or protocol order. The same review found that a majority of eligible patients still leave without naloxone, and that screening alone improved recommendations but did not reliably translate into the patient actually receiving a kit. That gap is a nursing handoff problem as much as a policy one. Build the check into your discharge routine so it is not the step that gets dropped when the department is full.
Distributing naloxone from the ED only prevents a death if the patient walks out with the kit and the confidence to use it.
Teach overdose recognition and the response steps
Education is the part that travels home with the patient. Keep it simple and have the patient and any accompanying family teach it back to you.
Start with recognizing an overdose. MedlinePlus describes the signs as excessive sleepiness, not waking to a loud voice or a firm rub to the center of the chest, shallow or stopped breathing, and small pupils. The CDC adds discolored skin and slow or shallow breathing with choking or gurgling sounds.
Then walk through the response. For the nasal spray, MedlinePlus instructs the responder to lay the person on their back, support the neck so the head tilts back, insert the nozzle into one nostril until the fingers touch the nose, and press the plunger firmly. Reinforce these points:
- Call 911 first or immediately after the first dose. Naloxone is a bridge, not a substitute for emergency care.
- Place the person on their side in the recovery position after dosing to reduce the risk of choking.
- Repeat dosing if there is no response. Per CDC, give one dose, then wait 2 to 3 minutes to watch for the return of normal breathing before giving a second dose. MedlinePlus describes repeating every 2 to 3 minutes with a new device in an alternating nostril if the person does not respond or relapses.
Two cautions are worth emphasizing at the bedside. First, naloxone reverses opioids only. It will not help an overdose from other substances, though it is still safe to give when opioids are suspected. Second, naloxone can wear off before the opioid does, so the person can slide back into overdose, which is exactly why staying with them and calling 911 matters. MedlinePlus also notes that overdoses involving longer-acting opioids such as buprenorphine may require additional doses.
Train the people who will actually be in the room
The patient is often not the one who administers naloxone. MedlinePlus is explicit that family members, caregivers, and the people who spend time with the patient should know how to recognize an overdose, use the device, and call for help. When a partner or parent is at the bedside, include them in the teaching and the teach-back. Confirm they can physically open the kit, since a sealed package opened for the first time during an emergency is a setup for failure.
Practical, plain-language coaching helps: where to store the kit so it is findable, checking expiration dates, and the reassurance that giving naloxone to someone who turns out not to be overdosing on opioids will not harm them.
Close the loop with documentation and follow-up
Finish the encounter the way the rest of nursing care is finished. Document what was dispensed, that overdose education and a return demonstration were completed, and who received the teaching. The ED scoping review pairs naloxone distribution with referral to treatment, peer recovery support, and behavioral counseling, and notes that multifaceted programs achieve higher provision rates than a single handoff. Within your scope and facility policy, connect the patient to those resources and to medication for opioid use disorder where available. The goal is not only a kit in the bag but a warm handoff to ongoing care, so the next overdose has a responder ready and a path away from the ED.