Naloxone Dispensing and Standing Order Documentation

Documents naloxone dispensing under a standing order and the associated patient education, counseling, and follow-up actions.

Dispensing Encounter

• Date of Dispensing
  Select the date naloxone was dispensed.
• Time of Dispensing
  Optional time of dispensing for audit trail purposes.
• Dispensing Location
  Select where the naloxone was dispensed.
• Recipient Type
  Identify who received the naloxone kit.
• Relationship to Patient
  If the recipient is not the patient, describe the relationship.
• Standing Order or Protocol Reference
  Enter the standing order, protocol, or policy reference used for dispensing.

Naloxone Product Details

• Naloxone Formulation
  Select the naloxone formulation dispensed.
• Brand Name
  Optional brand name if applicable.
• Strength / Concentration
  Optional product strength or concentration.
• Quantity Dispensed
  Enter the number of naloxone units or kits dispensed.
• Lot Number
  Optional lot number for inventory and traceability.
• Expiration Date
  Optional expiration date of the dispensed product.

Education and Counseling

• Was naloxone counseling offered?
  Indicate whether counseling was offered at the time of dispensing.
• Was counseling accepted?
  Record whether the recipient accepted counseling.
• Education Topics Covered
  Select all topics covered during education.
• Education Method
  Select how education was delivered.
• Teach-back completed?
  Indicate whether the recipient demonstrated understanding using teach-back.
• Education Notes
  Document any additional counseling details, questions asked, or barriers identified.

Safety, Consent, and Follow-up

• Consent / Disclosure Acknowledged
  Confirm that required disclosure language was provided before collecting any PII.
• Were any safety concerns identified?
  Indicate whether any immediate safety concerns were identified during the encounter.
• Safety Concern Details
  Describe the concern using minimum necessary detail.
• Referrals Made
  Select any referrals or follow-up actions provided.
• Follow-up Needed?
  Indicate whether follow-up is needed after this encounter.
• Follow-up Plan
  Describe the follow-up plan, owner, and timing.

Staff Attestation

• Staff Name
  Enter the name of the staff member completing the record.
• Staff Role
  Enter the staff member's role or credential.
• Attestation
  Confirm the accuracy of the record and the dispensing authorization.