A Nurse-Driven Pathway to Improve Screening and Treatment of Opioid Withdrawal

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Presentation: 29:16


Background: Heroin and opioid overdoses have become the leading cause of accidental death in Pennsylvania. Often, patients are admitted for medical reasons and the addiction management is what complicates and prolongs length of stay.

Purpose: The purpose of this quality improvement project is to identify a standardized method for screening, assessing, and treating Intensive Care Unit (ICU) patients with a primary or secondary diagnosis of opioid withdrawal.

Methods: A retrospective chart review of opioid positive (+) urine drug screen (UDS) patients in the ICU over a one-year period was completed at the start of the project. The pilot timeframe spans a three-month period from May 1, 2017 – July 31, 2017. The scope includes all Bryn Mawr Hospital (BMH) ICU patients during this period. Exclusions include non-BMH, non-ICU patients. Several tools were used during the pilot including a Data Collection Tool and the Clinical Opiate Withdrawal Scale (COWS). All patients in the ICU pilot were screened upon admission for opioid use disorder. Patients with positive risk screen or UDS receive a baseline COWS score and then every four hours (or more frequent if needed). The additional medications and treatments, COWS scores, and falls, restraints, etc. were all recorded on Data Collection Tool during pilot.

Results: The improved process during the pilot resulted in a decreased length of stay by 2.86 days and to decrease missed screens by 82%. The pilot also demonstrated that clinicians must combine early risk screening at admission with UDS to identify patients at risk for all inpatients.



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