Date of Completion

Fall 12-1-2023

Document Type

Open Access Project

Degree Name

Doctor of Nursing Science (DNS)

Faculty Advisor

Lisa Heelan-Fancher, PhD, FNP-BC, ANP-BC, CNE

Site Advisor

Alana Nagle, MD-MS

Second Reader

Edith Barrett, PhD, RN, PC

Abstract

Abstract

Background: In 2021,106,699 people died from a drug overdose and of these deaths, over 75% were related to illicit or prescription opioids (Centers for Disease Control, 2023). At two in-patient community crisis stabilization units for psychiatric care, many patients have a comorbid diagnosis of a substance use disorder and another mental illness. Treatment with Buprenorphine/naloxone (Suboxone) is associated with decreased opioid overdoses and related deaths; however, Suboxone inductions have not been a part of admission treatment.

Methods: This quality improvement (QI) project initiated a Suboxone protocol for eligible patients on two crisis in-patient stabilization units. The outcomes included measuring the number of Suboxone prescriptions prescribed, the time it took for patients to start Suboxone when admitted to the unit, the number of referrals to Suboxone providers at discharge, and to evaluate the nurse’s knowledge, comfort and confidence in identifying and assessing for opioid use, dependence and withdrawal symptoms.

Interventions: A Suboxone protocol was developed and adapted from the Boston Medical Center’s Outpatient Based Addiction Treatment (OBAT) program. A skills based educational session for nurses and team members was created that reviewed the Suboxone protocol and motivational interviewing techniques. Within the skills based educational session, pre/posttests were used to assess the nurses’ understanding of this new protocol with follow-up post assessments at one and two months. Checklists were developed to measure outcomes.

Results: Four patients were eligible to receive Suboxone during the QI project timeline, three of which required an induction and outpatient referrals at time of discharge. All four patients were able to receive the induction or an increase of Suboxone on the same day they met the nurse practitioner. Nurses’ knowledge, confidence, and comfort increased in assessing for opioid withdrawal. Beliefs about medication adherence treatment (MAT) and a patient being sober also improved as did nurse provider’s comfort working with patients receiving MAT.

Conclusion: The educational session will now be an integral part of the orientation process of new nurses and providers that work on the crisis Stabilizations Units.

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