The Intersecting Epidemics of Opioid Use Disorder and Infectious Diseases: The Role of the Medical-Surgical Nurse in Providing Evidence-Based Opioid Use Disorder Care
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Publisher:The Ohio State University
Series/Report no.:The Ohio State University. College of Nursing Doctor of Nursing Practice Final Document Projects
The intersecting epidemics of opioid use disorder (OUD) and infectious diseases comprise an escalating public health crisis in the United States. Hospitalization provides a unique opportunity to initiate and coordinate OUD care in patients presenting for other medical-surgical reasons. Most nurses are not trained to deliver evidence-based OUD care. The purpose of the project was to provide education on use of The Clinical Opiate Withdrawal Scale (COWS) to assist medical-surgical nurses in recognizing and managing clinical manifestations of opioid withdrawal in the adult inpatient population. The population and setting of interest were opioid-dependent patients admitted with an injection drug-related infection and the nurses caring for them at a large academic medical center in the Midwest. The project entailed a retrospective chart review and an anonymous survey administered to medical-surgical nurses during two time points. Outcome measures included frequencies of EMR documentation of COWS scores and buprenorphine administration in addition to mean scores and level of agreement of survey responses examining perceived nurse competency of assessment, intervention, recommendation, resource use, beliefs, and attitudes associated with caring for people with OUD. Post-education implementation chart review revealed a 43% increase in documentation of COWS scores. An increase in mean scores was reported in perceived nurse competency related to resource use over time (pre x=3.83, post x= 4.06; p=0.0070, t=2.73). Yet education alone was insufficient in improving nurse attitudes and beliefs (pre x=3.9, post x=3.73; p=0.2546, t=-1.17) towards caring for people with OUD. This project highlights significant gaps in care and uncovers hidden nursing costs associated with caring for this complex population. Findings can be used to inform efforts to increase assessment, evaluation, and treatment of people with OUD who are hospitalized for other medical-surgical reasons; to decrease the pervasive stigma perpetuating care; and to improve the quality of life, emotional well-being, and job satisfaction of frontline nurses caring for this vulnerable population. Education, structural resources, organizational culture, and role support from colleagues are imperative to support nurses and improve attitudes and beliefs in caring for people with OUD and ultimately improve quality of care, increase engagement in patients and care providers, and reduce health care costs.
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