HomeMy WebLinkAboutPD16-260 - Original - King County Behavioral Health and Recovery Division - Contract - 04/01/16 geme n I
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Document
CONTRACT COVER SHEET
This is to be completed by the Contract Manager prior to submission
to City Clerks Office. All portions are to be completed.
f you have questions, please contact City Clerk's Office.
Vendor fame: King County Behavioral Health and Recovery [division
Vendor Number:
,JD Edwards Number
Contract (umber: �9)Lo ).
This is assigned by City Clerk's Office
Project Name: MOA for Narcan Naloxone
Description: ❑ Interlocal Agreement ❑ Change Order ❑❑ Amendment ❑ Contract
❑ Other:
Contract Effective Date: April 1, 2016 Termination Date Dec. 31, 2016
Contract Renewal Notice (Days): 30
Number of days required notice for termination or renewal or amendment
Contract Manager: Rob Scholl Department: Police
Contract Amount: no cost
Approval Authority: Z Department Director Q Mayor, City Council.
Detail: (i.e. address, location, parcel number, tax id, etc.)
Partnership between BHRD and KPQ for the maintenance of Narcan (or other naloxone)
kits and the application of Narcan to individuals requiring opiate antidote intervention.
As of 08/27/14
Memorandum of Agreement Between
King County Behavioral Health and Recovery Division
And
Kent Police Department
I, SUBJECT
The following Agreement is entered into between King County Behavioral Health and Recovery
Division, hereafter, BHRD, and Kent Police Department hereafter, KPD. The Agreement is in effect
between April 1, 2016 and December 31, 2016.
I1. PURPOSE
The purpose of this Agreement is to describe and assure continued partnership between BHRD and
the KPD for the maintenance of Narcan (or other naloxone) kits and the application of Narcan to
individuals requiring opiate antidote intervention.
Ill. DEFINTIONS
Narcan: Generic name naloxone, is a prescription medication used to treatment opiate overdose.
Narcan is indicated for reversal of respiratory depression or unresponsiveness in the setting of opiate
overdose. It is a narcotic antagonist which blocks the opiates in the body.
IV. RESPONSIBILITES
A. BHRD agrees to the following:
1, Provide or coordinate initial training on how to administer Narcan or opiate antidote
intervention, if desired,
2. Coordinate Narcan kit orders for KPD with pharmacy,
3. Provide the Narcan kit(s)without a cost to the KPD and will refill the kits as resources
allows; and
4. Provide forms in an electronic format for reporting and data collection purposes.
B. KPD agrees to the following:
1. Provide all services under this agreement in compliance with BHRD Policy and
Procedures,
2. Coordinate with BHRD around the provision of services under this memorandum of
agreement,
3, Staff Training
a. Ensure all staff are trained to administer the intranasal form of Narcan,
b. Ensure all staff receive an annual refresher training on Opiate Overdose
Prevention and Narcan administration, and
4, Ordering, Delivery and Storage of Narcan Kits
April 2016
Memorandum of Agreement
a. Maintain Narcan kits in appropriate conditions in accordance with pharmacy
and manufacturer recommendations,
b. Naloxone kits shall be ordered through BHRD. Completed Naloxone Kit
Request Forms shall be submitted to odprevention(a kingcounty.gov.
Pharmacy will deliver Narcan to KPD or make other arrangements so that KPD
can obtain Narcan,
C. Narcan medication shall be kept in an Overdose Prevention Kit and will be
stored according to the manufacturer's recommendations and KPD policy and
procedures, and
5. Quality Assurance
a. KPD shall create and maintain operational policy and procedures related to
opiate overdose response and Narcan administration. The policy and
procedures shall include:
Guidelines for staff response to a suspected opiate overdose,
Staff training,
• Documentation standards related to staff administration of Narcan to
residents, and
o Guidelines to monitor Narcan supplies and ordering replacement kits
when refills are needed. This includes disposal of Narcan
medication that has expired.
b. KPD shall seek guidance from BHRD staff, as needed, as it relates to the
provision of services under this memorandum of agreement.
6. Reporting Requirements
A. Incidence and Loss Reports- KPD shall submit an Opiate Overdose Incident&
Loss Form to BHRD each time a Narcan kit is applied to an individual, lost, stolen,
expired, or for any other reason the kit is no longer available for use.
Completed forms shall be faxed or emailed to BHRD within 48 hours of the
occurrence: Attn: Ileana Janovich via Fax 206-296-0583 or via secure email at
od revention kin count . ov.
B. One-Time Only Reports- Upon request from the BHRD, KPD shall submit one or
more brief summaries of sample success stories accompanied by a release of
information as provided by the BHRD. Person identifying information should NOT
be included.
C. Otherwise suitable documentation mutually agreed upon.
V. CONFIDENTIALITY
All data concerning persons who received Narcan administration and their services shall be held in
the strictest confidence by both organizations. Information on individuals shall not be disclosed
directly or indirectly except where authorized by the person or requested by law.All information,
records, and data collected in connection with these services shall be protected from unauthorized
April 2016
Memorandum of Agreement
disclosure in accordance applicable regulations set forth in the Code of Federal Regulations (42 CFR
Part 2) and compliant with all Federal HIPAA requirements.
VI. COORDINATION
Erin James and Ileana Janovich will be the primary contact between KPD and King County BHRD to
collaborate on responding to information requests and resolving questions that may arise.
VII. DISPUTE RESOLUTION
The parties shall use their best, good-faith efforts to cooperatively resolve disputes and problems that
arise in connection with this memorandum of agreement. Both parties will make a good faith effort to
continue without delay to carry out their respective responsibilities while attempting to resolve the
dispute under this section.
If there is a dispute of the terms and outcomes of this Agreement, the parties that are involved with
the dispute first work with the BHRD Assistant Director to resolve the matter. If the matter is
unresolved, both parties agree to follow King County dispute resolution protocols and procedures to
resolve the matter.
Vlll. TERMINATION
Either BHRD or KPD may terminate the Agreement at a date prior to the completion date specified in
this Agreement, in whole or in part, upon thirty days written notice. Required reports and/or unused
Narcan kits shall be returned to BHRD or pharmacy, if applicable.
IN WITNESS HERETO, the King County Behavioral Health and Recovery Division and the KPD below, have
executed this Agreement as of the dates written below:
KING COUNTY BHRD } EEO i
Namer of Pro 'der Agency(Please type or print)
FOR
Signat a Sig at re
Kea
Jim VollendrofF, Director Name, Title (Please type or print)
�_e --t A 6)6(1�r�ll�
Date Date
April 2016
Memorandum of Agreement