Inpatient hospitalization may serve as a reachable moment for initiating and coordinating substance use disorder (SUD) treatment, including medication treatment for opioid use disorder (OUD). Liebschutz and colleagues examined whether opioid-dependent patients who were hospitalized for other medical reasons and then received buprenorphine induction followed by linkage to buprenorphine treatment, had lower opioid misuse at 6-months compared to those who only underwent detoxification during hospitalization. The study found that those linked to treatment had greater long-term use of medication treatment for OUD and more often reported zero days of opioid misuse (Liebschutz, Crooks, & Herman, 2014).
Similarly, another study also found that inpatient hospitalization may be an effective time for reaching patients who need treatment, but are not actively seeking it at the time of admission, as the reality that substance use has negatively affected their health becomes evident. The study emphasized the importance of: non-judgmental, caring staff for garnering patient trust; not pressuring patients into treatment; and improved care coordination and timely transition to SUD treatment (Velez, Nicolaidis, Korthuis, & Englander, 2016).
Insights From a Nurse
Elizabeth Bennett, RN, BSN
Brigham and Women's Hospital in Boston, Massachusetts
Showing acceptance and advocating for patients with OUD
"The best thing nurses can do is show acceptance and advocate for your patients because you may be the only person who is going to do it. This may be their one opportunity. When a patient is ready to accept treatment, the opportunity must be acted on as soon as possible. Nurses can support them in follow[ing] through with that decision."
Getting Started: Key Considerations for Success
Elizabeth Bennett, RN works in an inpatient, medical step-down unit at Brigham and Women's Hospital in Boston, Massachusetts—connecting patients to SUD treatment. Below she shares a few tips for other nurses in similar settings.
1. Get to Know Your Local Resources & Learn about Addiction
Participate in hospital-wide initiatives related to substance use. Inquire about opportunities to participate, to help spread the word about ways to help patients, and best treat substance use disorder. Ms. Bennett offered a couple of examples of how Brigham and Women’s Hospital 1) provided naloxone training in their main lobby during Recovery Month and 2) hosted a drug take back program for employees to bring in their prescriptions so the pharmacy could dispose of them properly.
Get familiar with local resources. Elizabeth recommends learning more about the addiction programs and resources in the area; it can be comforting for patients when nurses can suggest programs that have worked for others in the past. Get to know what programs are available in the area through SAMHSA’s Behavioral Health Treatment Services Locator.
Learn to spot risk factors. Knowledge of risk factors for addiction is important when providing education to patients being discharged on opioid medication. Ms. Bennett shares that “… keeping risk factors in mind can assist with emphasizing certain aspects of discharge education that may be more relevant to certain individuals.”
Become familiar with patients’ substance use history. Ms. Bennett notes that, “Connecting with patients and learning their background story can further promote understanding and acceptance from nurses.”
2. Considerations for Patient Care
Offer nonjudgmental, compassionate care. It’s important to keep in mind that patients in withdrawal from opioid use will be experiencing uncomfortable symptoms. Ms. Bennett recommends focusing on treating these symptoms by keeping the room calm and quiet and offering anti-nausea and anti-diarrheal medications to help patients. Review this article for more information on offering compassionate care and about nurses’ unique position to positively affect the health and well-being of patients with addiction.
Show a united front as a medical team. Nurses often initiate safety or care plans with the patient, so Ms. Bennett suggests sharing the plan with patients so they have a platform to react to provide input on their medical care. If a patient is escalating, or disagrees with the plan, Elizabeth emphasizes the importance of interdisciplinary care, and suggests initiating a safety meeting with a social worker, care coordinator, and other relevant members of the medical team to revise the plan. Utilizing all resources available to develop the best plan for the patient will help them feel like everyone is there for them, and for their success.
Check your language. One of the Brigham and Women’s Hospital’s initiatives was to create a hospital-wide pledge against stigma, since using stigmatizing language can negatively affect patients. Reviewing this guide with preferred terms versus those to stay away from can be a good place to start.
Be prepared if a patient is not ready to accept treatment. Advocate for, and facilitate whatever treatment plans you can. Elizabeth shared that “harm reduction saves lives until a person is ready to accept treatment.” If willing, provide a patient with information on naloxone training, Hepatitis C or HIV testing, and safe injection sites. Meeting them at their readiness level and providing a safe, nonjudgmental environment to discuss their options is also key.
Visit NIDAMED for additional resources for you and your patients.
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