ED Buprenorphine Induction to Treat Opioid Use Disorder: Program Development and Evaluation
Problem/Significance: Opioid overdoses are one of the leading causes of death in the state of Wisconsin. Emergency Department (ED) visits related to opioid use disorder (OUD) have increased twofold over the past decade thus making them a critical access point well positioned to provide the link for patients to opioid use disorder treatment. Medication-assisted treatment (MAT) plans in addition to counseling and behavioral therapy, are essential to maintaining opioid remission.
Background: Despite evidence that supports starting buprenorphine in the ED, clinicians are reluctant to be prescribers due to lack of training and clinical guidelines.
Purpose: The goal of this doctoral project was to improve the early assessment of OUD, establish a system of care that initiates MAT in the ED, improve compliance with immediate engagement in peer recovery coach services, and referral to outpatient treatment programs.
Method: This program development plan was guided by the plan-do-study-act model and SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence), which provide a framework for reporting new knowledge about how to improve health care.* The evaluation was guided by Stufflebeam’s** input, process, product (CIPP) model.
Results: Outcomes included a 5% increase in nursing assessments, a 11% increase ED buprenorphine doses administered, a 16% increase in naloxone kit distribution, insight into the barriers and facilitators of the program, as well as the identification of potential programs and services eligible for grant funding.
Conclusion/Implications: Recovery coach programs are a valuable link to sustainable recovery. Implementation of ED buprenorphine inductions programs are complex, iterative processes that need to be tailored to the unique needs of all participants. Program success has the potential to save lives.