Hostname: page-component-7c8c6479df-24hb2 Total loading time: 0 Render date: 2024-03-29T09:15:58.692Z Has data issue: false hasContentIssue false

P069: Implementing supervised consumption service access for emergency department patients

Published online by Cambridge University Press:  13 May 2020

N. Lam
Affiliation:
University of Alberta, Edmonton, AB
R. Rosenblum
Affiliation:
University of Alberta, Edmonton, AB
T. Kaban
Affiliation:
University of Alberta, Edmonton, AB
K. Dmitrienko
Affiliation:
University of Alberta, Edmonton, AB
D. Oczkowski
Affiliation:
University of Alberta, Edmonton, AB
K. Dong
Affiliation:
University of Alberta, Edmonton, AB

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Background: Unintentional opioid overdoses in and around acute care hospitals, including in the ED, are of increasing concern. In April 2018, the Addiction Recovery and Community Health (ARCH) Team at the Royal Alexandra Hospital opened the first acute care Supervised Consumption Service (SCS) in North America available to inpatients. In the SCS, patients can consume substances by injection, oral or intranasal routes under nursing supervision; immediate assistance is provided if an overdose occurs. After a quality assurance review, work began to expand SCS access to ED patients as well. Aim Statement: By expanding SCS access to ED patients, we aim to reduce unintentional and unwitnessed opioid overdoses in registered ED patients to 0 per month by the end of 2020. Measures & Design: Between June 13-July 15, 2019, ARCH ED Registered Nurses were asked to identify ED patients with a history of active substance use who may potentially require SCS access. Nurses identified 69 patients over 43 8-hour shifts (range 0-4 patients per shift); thus, we anticipated an average of 5 ED patients per 24-hour period to potentially require SCS access. Based on this evidence of need, ARCH leadership worked with a) hospital legal team and Health Canada to expand SCS access to ED patients; b) ED leadership to develop a procedure and flowchart for ED SCS access. ED patients were able to access the SCS effective October 1, 2019. Evaluation/Results: From October 1 to December 1, 2019, the SCS had 35 visits by 23 unique ED patients. The median time spent in the SCS was 42.5 minutes (range 14.0-140.0 minutes). Methamphetamine was the most commonly used substance (19, 45.2%), followed by fentanyl (10, 23.8%); substances were all injected (91.4% into a vein and 8.6% into an existing IV). In this time period, there were zero unintentional, unwitnessed opioid poisonings in registered ED patients. Data collection is ongoing and will expand to include chief complaint, ED length of stay and discharge status. Discussion/Impact: Being able to reduce unintentional overdoses and unwitnessed injection drug use in the ED has the potential to improve both patient and staff safety. Next steps include a case series designed to examine the impact of SCS access on emergency care, retention in treatment and uptake into addiction treatment.

Type
Poster Presentations
Copyright
Copyright © Canadian Association of Emergency Physicians 2020