Get New York State Public Safety Naloxone Quality Improvement Usage ... - Dhses Ny

This guide provides a step-by-step approach to complete the New York State Public Safety Naloxone Quality Improvement Usage Report. Ensuring accurate reporting can support quality improvement efforts in public safety organizations. Follow the instructions carefully to fill out the form online.

Follow the steps to complete the form accurately and efficiently.

1. Press the ‘Get Form’ button to access the form and open it in the digital editor.
2. Fill in the 'Arrival Time of EMS' and 'Arrival Time of Responder' fields. Ensure you use the correct format for time (AM/PM).
3. Enter the 'Date of Overdose' using the appropriate date format.
4. Indicate the 'Gender of the Person Who Overdosed' by checking the appropriate box (Male, Female, Unknown).
5. Provide the 'Agency Case #' and 'ZIP Code Where Overdose Occurred' in their respective fields.
6. In the 'Aided Status Prior to Administering Naloxone' section, check one box for each category (Responsiveness, Breathing, Pulse) that accurately describes the person's condition.
7. In the 'Aided Overdosed on What Drugs' section, check all substances that apply to the situation.
8. Record the 'Number of naloxone vials used' and how long the first dose took to work.
9. Document the aided person's responses to naloxone in the 'Aided's response' section by selecting the relevant options.
10. If a second dose was administered, specify how long after the first dose this occurred and how many vials were used.
11. Check all applicable 'Post-naloxone symptoms' the aided person experienced.
12. Note any other actions taken by the responder under 'What Else was Done by the Responder'.
13. Indicate if naloxone was administered by anyone else at the scene and detail their roles.
14. Select the appropriate option for 'Disposition' regarding the aided person's transport.
15. Answer whether the person lived or not after receiving naloxone.
16. Complete the 'Hospital Destination' and 'Transporting Ambulance' fields if applicable.
17. Fill out the final section for administering responder's information, including agency, name, badge number, and email.
18. Once completed, review the form for accuracy, then save your changes, and proceed to download, print, or share the document as needed.

Complete the New York State Public Safety Naloxone Quality Improvement Usage Report online today to contribute to public safety efforts.