Evaluating the effectiveness of the Hawaii keiki naloxone training program: A quality improvement initiative

Abstract

Background: School-based interventions play a vital role in addressing the opioid crisis. The Hawai‘i Keiki program, a partnership between the University of Hawai‘i and the Department of Education, provides naloxone and CPR training to DOE staff as part of a nurse-led initiative to strengthen overdose response in schools.Purpose: This quality improvement project evaluated the effectiveness of the Hawai‘i Keiki Naloxone Training Program by assessing trainer confidence, identifying areas for improvement, and aligning with national best practices. Methods: Using the Iowa Model, the project involved a literature review, a comparison of national programs, a pre-training needs assessment, training updates, a post-training follow-up session, and a post-survey evaluation. Descriptive and inferential statistics were applied to Likert-scale data, and qualitative feedback was gathered during follow-up. Results: Post-survey data (n=23) showed statistically significant increases in trainer confidence across all domains (p < 0.001), with comfort scores improving by +1.1 to +1.3 points. Trainers reported greater readiness to respond to overdoses and deliver training. Qualitative feedback highlighted improved clarity, resource access, and the value of peer discussion. The program aligned with national standards, with strengths in accessibility, nurse-led delivery, and school integration. Conclusion: The Hawai‘i Keiki Naloxone Training Program effectively enhanced trainer preparedness. Continued development such as tracking naloxone use, offering follow-up sessions, and providing refresher training will support long-term impact and model excellence in school-based overdose response.