Graduation Semester and Year

2015

Language

English

Document Type

Dissertation

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Diane Snow

Abstract

Opioid use disorder is an epidemic that has a devastating impact on public health, morbidity and mortality, and the escalating economic burden of healthcare (U.S. Department of Health & Human Services, 2013). The rates of prescriptive and nonprescriptive opioid misuse are on the rise (Compton, Boyle, & Wargo, 2015). One approach in managing opioid use disorder is opioid replacement therapy (ORT). In response to increasing rates of opioid use disorder, the Drug Addiction Treatment Act of 2000 permitted "qualifying physicians" to treat opioid use disorder in an office-based setting. The FDA approved medication buprenorphine, a partial opioid agonist, is used in the treatment of opioid use disorder in an office-based setting. Despite its efficacy, there is significant concern about the potential misuse and diversion of buprenorphine (Federation of State Medical Boards, 2013 ). The purpose of the Quality Improvement project was to increase drug screens and prescription drug monitoring program assessments (PDMP) for patients enrolled in ORT. Drug screens and PDMP assessments are commonly used to mitigate the potential risk of misuse and diversion associated with ORT. Quarterly random drug screens and PDMP assessments were implemented for patients enrolled in ORT in an office-based setting in Dallas, Texas. In this setting there are three clinicians. Data collected included the number of drug screens and PDMP assessments. Retrospective data included 60 chart reviews for data before intervention, and 64 charts after intervention. The frequency of drug screenings and PDMP assessments were measured using a Monitoring Score. The six-month study period was April 1, 2015 to September 30, 2015. Charts met criteria for inclusion if the patient enrolled in ORT was in maintenance treatment, diagnosed with opioid use disorder, and at least 18 years of age or older. Charts were excluded if the patient was enrolled in induction ORT, hospitalized during the study period, or under the age of 18 years old. Clinicians demonstrated a significant increase in the number of drug screens and PDMP assessments post protocol implementation. Prior to implementing the protocol, 68% of patient charts showed a Monitoring Score of 0, indicating no record of drug screens or PDMP assessments. Post implementation, there were no charts reviewed that reflected a Monitoring Score of O reflecting a significant increase in drug screens and PDMP assessments. In fact 80% of the charts had a Monitoring Score of 3 or higher, with 4 being maximum assessment possible. The Opioid Use Disorder Protocol served as a tool to engage clinicians in a comprehensive ORT treatment plan that promotes safe prescribing. The QI project suggests that implementing a guideline for the frequency of drug screenings and PDMP assessments is an effective way to reinforce clinician behavioral change in managing the potential risk of ORT. DNP scholarly projects using quality improvement initiatives are significant contributions to nursing practice and improving health outcomes. This protocol has made a positive impact on clinician practice; clinicians report that the protocol improved the quality of care provided at Live Oak Counseling.

Disciplines

Medicine and Health Sciences | Nursing

Comments

Degree granted by The University of Texas at Arlington

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