COMPILED BY JOHN JOSEPH PARKER, CONTRIBUTING EDITOR
A FEW YEARS AGO, A 60-YEAR- old Elizabeth, New Jersey, man named Nathan was treated for a severe infection in the Emergency Department at Trinitas Regional Medical Center. If not for an innovative program that calls for drug/alcohol screening of all patients, Nathan may have been released and eventually died of a drug overdose. Instead, he was treated for addiction and has been sober for the past two years.
Drug screening is not a new practice for Trinitas. In 2012, screening became part a Trinitas initiative known as the Delivery System Reform Incentive Project (DSRIP). Since then, patients are assessed upon admission using a standardized tool called AUDIT (Alcohol Use Disorders Identification Test).
It’s just recently that the United States Preventive Services Task Force has recommended that all healthcare providers screen adults for substance use. When appropriate, the Patient Health Questionnaire is administered as a screening for depression, as well.
When it is apparent that the patient is using/abusing substances/medications, the nurse engages the patient in an open-ended interview about all patterns of use/abuse. The screenings take only minutes to complete and when administered in a non-threatening, normalized way, patients are very forthcoming. Based on the assessments, the Clinical Institute Withdrawal Assessment Protocol (CWIA) is followed for those patients who are at risk for detoxifying.
“We immediately identify patients using substances, which then informs the care plan,” says James McCreath, Ph.D., vice president, Behavioral Health & Psychiatry at Trinitas. “When the CIWA protocol has been used, the length of inpatient stay for those patients is lower than the baseline. There has been a decrease in number of transfers from medical floors to the Intensive Care Unit. The number of 30-day re-admissions has dropped. There has also been an increase in the number of referrals to substance abuse treatment providers.”
When the AUDIT screening is complete, the score is entered into the electronic medical record (EMR). The EMR electronically notifies the Addiction Department of all screenings that show patients at risk. The addiction counselor then goes bedside immediately to ascertain what, if anything, the patient wants to do about their use. In some cases, the counselor aims to educate the patient. In other cases, the counselor provides a warm handoff to an addiction provider upon the patient’s discharge.
Finally, the devastating depth and scope of the opioid crisis is being recognized. In 2017, more than 70,000 Americans died from a drug overdose. Addiction to alcohol, legal medications and illegal substances, can happen to anyone regardless of ethnicity, income, age or educational background. In other words, there is no one profile of an addict.
“Since 2012 we have screened more than 57,000 patients at Trinitas, no doubt saving the lives of countless patients whose substance abuse was identified early,” explains Gary S. Horan, FACHE, president and CEO of Trinitas. “We made a significant, culture-changing decision when starting the DSRIP initiative—every inpatient nurse would be trained to use the AUDIT screening as part of the initial nursing assessment. This normalized the screening for alcohol/substance use.”