Date of Degree

12-2021

Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

Program

Nursing

Advisor

Jean Dols

Abstract

Patients with opioid use disorder are at increased risk for overdose and death should they relapse due to reduced opioid tolerance after a period of abstinence. A retrospective chart review was performed at an inpatient drug and alcohol treatment center to identify areas in need of improvement. The global aim of this project was to promote patient adherence to treatment, as well as increase the prevention of patient overdose and death after inpatient treatment. Project objectives include improving provider management of opioid use disorder through standardizing patient education, increasing prescription of relapse prevention medication, initiating prescription of naloxone at discharge for overdose reversal, and consolidating documentation following the 2020 American Society of Addiction Medicine (ASAM) guidelines and standards of care. Provider education sessions were held. The sessions reviewed improvement opportunities identified in the chart review, changes in the ASAM guidelines, evidence-based practices, and methods to increase interprofessional collaboration. Provider interventions included patient education addressing harm reduction strategies, prescription of relapse prevention medication with patient consent, and standardized documentation of medication-assisted therapies offered. The rate of naloxone distribution increased from 0 to 88%. The rate of patients who trialed oral naltrexone increased by 7%, but the rate of naltrexone prescriptions at discharge and Vivitrol administration was unchanged. Only 20-30% of individuals who receive treatment for opioid abuse maintain long-term abstinence. Implementation of evidence-based care is critical to improve this vulnerable population’s treatment success and reduce the probability of overdose after treatment.

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