Developed by an interprofessional team, a new set of guidelines implemented at the Brigham this summer provides consistent, compassionate interventions to better support patients with opioid use disorder (OUD) and their care teams.
The Substance Use Disorder Nursing Working Group, which comprises General Medical Service clinical nurses, nursing leaders and professional development managers, as well as the Psychiatric Nursing Resource Service, informed the nursing approach to care with these guidelines.
Jane Postizzi, BSN, RN, of Medical Intermediate Care on Braunwald Tower 16AB, shares how the guidelines have improved the care she provides and offers insights on how staff can enhance the experience of patients with OUD.
Approximately how often do you care for patients with OUD?
JP: At any given moment, our unit has at least one patient with OUD. On average, I estimate I care for such patients on a weekly basis.
Can you share how your experience caring for patients with OUD has changed over the years?
JP: When I first became a nurse, the idea of asking someone about opioid use or drug use was very intimidating for me. I often felt uncomfortable asking patients about drug use because I didn’t want to make them feel uncomfortable. At the time, I didn’t have the knowledge and resources to offer them that we now have. So, if a patient did divulge a drug use disorder, there wasn’t much I could offer as a nurse. Now that there is a standard assessment (the Substance Single-Question Screener) at admission for all patients, I find it much easier to approach these topics and offer the proper resources to help guide those conversations.
I have found, with further education and clinical discussions surrounding OUD, my approach to patients is more relaxed and encourages further dialogue.
Since the new guidelines were implemented in June, have you noticed a difference in the experience of patients with OUD?
JP: I have certainly noticed an improvement in the admission processes, specifically in the time of therapy initiation (if deemed appropriate). Medications such as methadone and Suboxone are being considered more thoroughly and prescribed in a timelier manner, which benefits our patients by decreasing their risk of experiencing withdrawal.
How do you think the guidelines will benefit patients and their families moving forward?
JP: I think these guidelines are helping to provide more structure to a topic that has been somewhat of a “grey area.” First, and most importantly, we are including the patient in their plan of care and treatment. Before any treatment plan can be therapeutic, the patient needs to be at a place where they are ready to engage in care. If a patient discloses that they have no desire to stop misusing opioids, the team can continue to offer support and resources without the challenges that come with trying to persuade someone to do something they are not ready for.
Can you provide an example of these challenges?
JP: Yes. If patients aren’t engaged in the treatment plan, they may demonstrate increased agitation and irritability, noncompliance with medication and treatment, and even leaving against medical advice. In these situations, patients feel as though no one is listening to them, and this also affects the morale of staff due to the stressful circumstances for the patient.
How does communication from the care team help to improve a patient’s experience?
JP: I think consistent communication is what some patients need most. If patients have knowledge of upcoming medication and dose changes and are made aware of the rationale by their primary physicians, the patient’s response to the treatment change is much more positive.
The guidelines help to open communication pathways for patients and their families in a manner that makes them feel safe and heard. I think patients with OUD/SUD are often stigmatized and labeled as “drug seekers” or “behaviorally difficult,” and, understandably, may be afraid to disclose their OUD.
Is there anything else you’d like colleagues to know about caring for patients with OUD or SUD?
JP: Recognizing these disorders as a disease rather than a choice is a huge first step. I would encourage those who work with patients with OUD/SUD to educate themselves and become familiar with the disorders. Even watching documentaries on the opioid epidemic and how it contributed to the struggles we see today can be eye-opening.