Using a collaborative team- based approach to enhance the inpatient management of Opioid Use Disorder (OUD)

• Published in: Pain management nursing 2024-04, Vol.25 (2), p.e166-e167
• Main Author: Chambers, Mary Beth
• Format: Article
• Language: English
• ISSN: 1524-9042; 1532-8635
• DOI: 10.1016/j.pmn.2024.02.062

The project's aim is to increase the number of patients with OUD discharged on medication for management of OUD (i.e. buprenorphine) by 150% within a year without increasing cost of care. Patients diagnosed with active OUD admitted to the hospital are at risk for developing dose dependent severe withdrawal symptoms if sufficient opioids for pain or opioid agonists for Medication Assisted Treatment (MAT) are not prescribed​. Initiation and continued outpatient treatment with FDA approved MAT ​improves the rate of abstinence from illicit opioids​, increases treatment retention​, reduces incidence of hepatitis C​, decreases discharge against medical advice rates, and reduces mortality​. The Define, Measure, Analyze, Improve and Control (DMAIC) model is being used to apply a structured approach to practice change. A multidisciplinary, group of stakeholders from a large multistate health system developed the aim statement and implementation plan. Data analyzed from the electronic health records for patients across the health system demonstrated OUD related diagnosis ranging from 2.4-4% for patients prescribed opioids as outpatients, no completed OUD screening questions on admission for at-risk patients, and new buprenorphine starts (range 2-7 per site from 2/1/23-5/1/23). Additional data collected include cost of care, length of stay, discharges against medical advice and readmissions. Interventions include enhancement of the admission screening question process, development of a multidisciplinary orderset for symptom management, development of multidisciplinary education, implementation of the Clinical Opioid Withdrawal Scale (COWS) and development of new patient education. The project is in the process of implementation with projected orderset go-live in May 2023. Pre and post education nursing learning needs assessment data are available demonstrating effectiveness of nursing education component prior to orderset go-live Improving care for OUD patients in this system's inpatient settings has required large multidisciplinary, sequenced implementation for newly designed interventions.