Premier Health on the Front Lines Fighting Opioid Addiction

Atrium Medical Center Joins Forces with City and Community Leaders to Fight Opioid Crisis

By Wendy Mitchell BSN, RN, CEN, clinical nurse manager, Emergency Trauma Center, Atrium Medical Center

Combating the opiate addiction epidemic requires a multidisciplinary approach including involvement from the community.  

Hospitals treat the immediate medical emergency, but who helps these patients once they are discharged? The city of Middletown brought together leaders from across the community in an effort to decrease the number of overdoses, as well as deaths resulting from overdoses.  

In June 2016, the Heroin Response Team for Middletown was created. Residents are referred to this team by emergency department officials, the courts, probation officers and treatment providers. This team, comprised of a police officer, paramedic and care coordinator make contact with the individual to offer resources for treatment. To date, this team has visited 377 individuals who have overdosed. Of that number, 194 have accepted the resources offered and walked into a treatment center. According to the most recent data from the Middletown Heroin Summit, Middletown has seen a decrease in overdoses and deaths related to overdose.  There were 113 overdoses reported in June; 73 in July; and 68 in August. Through September 18, 15 overdoses had been reported.  Deaths related to overdose totaled nine in June, five in July, and two in August.  As of September 18, there have been no reported overdose deaths in the city of Middletown for the month.  

Good Samaritan Hospital (closed in 2018) Emphasizes Safety for Caregivers of Addicts

By Christie Gray, chief nursing officer, Good Samaritan Hospital

At Good Samaritan Hospital, we have worked to educate our nursing staff on the safety steps to take when there is the potential for exposure to carfentanil or heroin.  This includes when and how to use personal protective equipment (PPE), when to call security for assistance, and what to do if you suspect illicit drug use or drug paraphernalia on a patient or visitor. In addition, the teams in the ED and ICU have implemented a support plan for the nursing team to address the potential for compassion fatigue when caring for opioid addicted patients. This plan has included both formal and informal education on addiction, informal debriefing after difficult patient situations, and sharing additional resources with the teams such as EAP and chaplain support.  

Miami Valley Hospital Starts Program for Drug-Addicted Babies

By Amy Clayton, RN, BSN

In 2010, the Neonatal Intensive Care Unit (NICU) at Miami Valley Hospital embarked on a journey to improve the care of infants born to mothers who take opioids (prescription or illegal) during pregnancy. These infants experience a physical withdrawal called neonatal abstinence syndrome (NAS). NAS is a group of symptoms, some of which include fussiness, crying, inability to sleep, fever, jitteriness, diarrhea, vomiting, and sneezing. Early detection and holistic treatment that incorporates both pharmacologic and nonpharmacologic interventions help improve outcomes for these infants. Babies are treated with medication for withdrawal, but need additional support, such as holding, rocking, and other quiet social interactions, to lessen the physical symptoms. As the number of babies born to opiate-addicted mothers increased drastically, many new strategies were adopted or discussed to improve the care provided. One option was to utilize volunteers to help hold and comfort infants when the parents or nurses are unavailable. Cuddlers help to fill the gap for the babies if a parent or nurse is unavailable. Activities of social interaction like cuddling support the neurological development and physiologic stability of NAS babies. 

This began the journey to start a volunteer cuddler program at MVH NICU. A partnership developed between the NICU, Volunteer Services, Risk Management, Human Resources and Legal Counsel to coordinate efforts to successfully implement the cuddler program. After reaching out to other facilities that utilized volunteer cuddlers, the team determined what had been successful. From that information, a job description and an orientation program were developed. Volunteers went through an interview process, a background check, a health screening, as well as an orientation class with instruction from nurses and occupational therapists. In July 2017, the volunteer Infant Cuddler Program was launched. Approximately 13 volunteers work in conjunction with the nursing staff in the NICU to provide comfort and compassionate care to the NAS infant.

The community response has been overwhelming. The program's launch garnered local and national media attention, and the MVH Volunteer Services office was deluged by calls from more than 1,000 interested volunteers. The long-term goal of the program is to provide a loving set of arms 24/7 for any baby suffering from NAS. The cuddler program is a bright spot for the community in the midst of the dark opiate epidemic.

Reference: ENA Connect, volume 41, Issue 8, August 2017. Pages 24-29.

Emergency Room War on Opioids

By Lisa Weaver RN, MSN, director, emergency services, Upper Valley Medical Center

Terry Fry BSN, MA, NEA-BC, chief nursing officer, Upper Valley Medical Center 

As a nation, we are facing many challenges within health care, among them opioid overdoses and addiction. Montgomery County leads the state in the rate of overdose deaths per capita. This challenge extends into Miami County, affecting Upper Valley Medical Center. 

UVMC’s emergency department has seen a slow but consistent rise in the number of opioid overdoses. In 2016 we saw 369 overdoses, including intentional, accidental, drug abuse, heroin intentional and accidental. So far in 2017, we have seen 297 patients, a 41 percent increase from the year-earlier period.

At UVMC, we are assessing how many opioid prescriptions we are writing through our emergency departments. We also are encouraging the use of nonpharmacological treatment modalities.

As mentioned in the last ENA (Emergency Nurses Association) Connect publication, “nurses are situated on the front lines: treating overdoses, handling pain complaints and caring for patients who may not have a primary care provider.”  ENA Connect is an online community for emergency room nurses. 

Patient education is one of the key things as nurses we can influence. We continue to research and understand opioids so we are prepared and able to share with our patients the risks of the medication and strategies to avoid developing a tolerance.  

For more information on this topic, go to ENA.

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