A DNP Evidence-Based Quality Improvement Project to Implement Harm Reduction in Patients with Multiple Myeloma
Keywords:Harm Reduction in Multiple Myeloma
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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
Problem: Multiple myeloma is a hematologic malignancy that often presents with accompanying significant bone pain, generally managed by pharmacologic therapy including opioids. Currently there are no standards for the management of long-term opioids for persons diagnosed with cancer. Purpose: This Doctor of Nursing Practice (DNP) evidence-based quality improvement project implemented the Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) tool, a screening tool used to identify patients at risk of substance use disorder, at a large urban academic Midwestern cancer center in the Multiple Myeloma clinic. This tool was implemented to identify at-risk persons for substance use disorder. Methods: New patients seen in the Multiple Myeloma clinic were screened for identification of who may be at risk of substance use disorder with the use of TAPS surveys. If completed, the survey was collected and reviewed by the Licensed Independent Social Worker (LISW). If a screen was positive, they were later contacted by the LISW to discuss the findings and offered a referral to a Harm Reduction counselor. Findings: In a three-month period from October 2018 - January 2019 there were 157 new patients seen and zero patients screened. In corresponding three-month period from 2019-2020 during implementation of this QI project, there were 178 patients seen, 19 of whom were screened and four were identified as at risk with a positive screen. However, all at risk patients identified declined a referral to Harm Reduction. Conclusion: Although the number of patients screened was low, there were still patients identified as at risk for substance use disorder which makes this project a success. More education among the team can eliminate some of the barriers. Substance use disorder screening should be continued.
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