Document Type
DNP Project
Publication Date
2026
Degree Name
Doctor of Nursing Practice
Faculty Advisor
Kerry Milner, DNSc, APRN, FNP-BC, EBP-C
Abstract
The increasing prevalence of non-opioid adulterants like xylazine, a veterinary tranquilizer, has introduced significant challenges in overdose recognition and management. Non-opioid adulterants cause central nervous system depression, respiratory compromise, and severe soft tissue injury that is not reversed by naloxone. Many healthcare organizations lack standardized clinical guidance for managing overdoses involving non-opioid adulterants, resulting in variability in care and increased risk for adverse outcomes. The purpose of this Doctor of Nursing Practice project was to update and implement an opioid overdose response policy incorporating evidence-based guidance for the recognition and management of overdoses potentially involving non-opioid adulterants. This was conducted in a Federally Qualified Health Center where the illicit drug supply has been contaminated with these substances. This evidence-based quality improvement project implementation was guided by the Model for Improvement and used Plan–Do–Study–Act (PDSA) cycles to test changes. A needs assessment identified gaps in the existing policy. Evidence reviews and stakeholder collaboration informed the updates to the policy emphasizing airway-first management, supportive respiratory care, wound assessment, and harm reduction strategies. The updated policy was approved by organizational leadership, uploaded to the organization’s policy management system, and disseminated to clinical staff via a leadership email on April 6, 2026. The email outlined key updates related to management of non-opioid adulterant-involved overdoses and directed staff to review the policy and complete attestation within the system. Concurrently, the associated learning management system educational module was assigned as part of standard training processes. An attestation process was initiated to support provider engagement. Implementation of the updated opioid overdose response policy, including integration into existing organizational infrastructure, was completed, and a corresponding learning management system educational module was deployed on April 6, 2026. This project represents an important initial step in translating emerging evidence into clinical practice through policy-level intervention. While early implementation supports integration of updated guidelines into organizational processes, evaluation of effectiveness will require ongoing assessment of staff training completion, adherence to the updated policy during clinical care, and outcomes related to management of suspected opioid overdose cases.
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Recommended Citation
Umbro, D. (2026). Implementation of an updated opioid overdose response policy to address xylazine-involved overdoses in a federally qualified health center [Unpublished DNP project]. Sacred Heart University.
Comments
A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.