Virginia Gov: Health Commissioner gives standing orders for residents to receive opioid reversal drug

Virginia responds to opioid crisis with standing orders written by State Health Commissioner Dr. Marissa J. Levine allowing residents to obtain opioid reversal drug naloxone from pharmacies. Has anyone seen a set of standing orders used in this way during a public health crisis? I’m thinking bold moves. Which is what I wholeheartedly support.

Governor McAuliffe:
“The overdose rates in Virginia have led me to agree with Dr. Levine that we are indeed experiencing a public health emergency. This declaration helps us respond in a nimble way to a rapidly changing threat, while the Naloxone standing order from Dr. Levine broadens our ability to get life-saving medication into Virginians’ hands.”

Source: Governor – Newsroom


From Medline:
You will probably be unable to treat yourself if you experience an opiate overdose. You should make sure that your family members, caregivers, or the people who spend time with you know how to tell if you are experiencing an overdose, how to use naloxone injection, and what to do until emergency medical help arrives.

Who will do the educating? Public health campaign to instruct people on what a opioid habit looks like so they know to be prepared with the reversal drug? Pharmacists to educate on how/when to use it? What’s the plan, where’s the funding, how are we going to implement, and in what way will we measure success.

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Bedside nurse personal

It’s a strange thing this working in a hospital. Your professional environment is people who are having the most painful, out of control times of their lives. Or maybe, and often in the medical-surgical ICU where I work, the realization that this is how their life is going to end. It’s heavy stuff. I love heavy stuff. I love being a critical care nurse.

I’m not that great at it yet. I started in February, oriented for 4 months, took patients while I did 9 months of additional training and education.  I use a lot of support from fellow nurses, pharmacists, physical therapy, speech therapy, and I couldn’t do hardly a thing without respiratory therapists. Some attendings are sent from heaven. Others can go well you know where. I’ve had a handful of very, very sick patients which have stayed with me for nights in dreams where I complete the tasks I wish I’d gotten to during my shift. I’ve had many not terrifyingly sick but fragile patients who kept me less occupied with medical needs and more busy with human needs: company, anxiety, hunger, bathroom stuff.

Bedside nursing and shift work? I thought it was something to be suffered through. But like the intensivist I respect and will one day impress always tells me: “You are wrong.”I have no desk. I’ve sent maybe 2 emails. I never know what I’m walking into, but I know it’ll be over and up to the next shift in about 13 hours. This is a relief (out of my hands) and a responsibility (don’t leave a mess for your coworkers).  I’ve never looked forward to work the way I do now. I also regularly come home and lose my mind. I have sworn I was going to quit at least 3 times. I have a new resume for every season. But the deeper in I get, the more I feel the need for the creativity, chaos, and appallingly funny bedside world.

Aside from the heaps of scientific and human condition knowledge I’ve gotten in the past year, bedside nursing has been a self-improvement miracle. Accomplishments I’m most proud of:


Always at the ready to receive the stern voice. “WHAT DID YOU DO TO MY VENT?” (Nothing I believed you when you said you would eat me if I changed the settings), “WHY HAVEN’T THE CULTURES BEEN SENT YET?” (No chance on peripheral access, gonna need that central line order I mentioned…) “YOU MESSED UP.” (Happens all the time. Tell me what I can do to fix it).

Learned to deliver a come to Jesus moment. I’m getting used to being the punching bag for upset, confused, desperate patients going through the worst of what life has to offer. People’s feelings have to go somewhere. But if your feelings are getting in the way of my care we’re going to have a come to Jesus. There’s the I’m going to come down on you like a ton of bricks with teeth and nails and repressed Catholic rage CTJ: “YOUR YELLING AT ME IS MAKING YOUR WIFE’S BLOOD PRESSURE DANGEROUSLY HIGH AND KEEPING ME FROM DOING MY JOB so please go to the waiting room and I’ll call you when we’re settled.” Alternately, the you are panicking so let me tell you exactly what you are going to do to get through this CTJ: “Your mother is dying. Please stop texting your vacationing siblings. Now is the last time you get to hold her hand and talk to her. It is going to be okay.”

As this first year as a critical care nurse comes to a close, I am so happy to be a humble and regularly humiliated newbie in my place. Hospital people are my people. And I plan on staying put for some time to come.*

*I will still look for a job selling insurance every time they float me to the step down unit.