The substance use intervention team: A hospital-based intervention and outpatient clinic to improve care for patients with substance use disorders

Abstract

Purpose In response to the opioid crisis, public health advocates urge hospitals to perform substance use disorder (SUD) screening, brief intervention, discharge planning with referral to treatment, and naloxone education. Universal screening makes specialized treatment available to all patients and decreases stigma around SUDs, allowing patients and providers to address SUDs during their hospitalization. Additionally, hospital and emergency department–initiated medications to treat SUD improve patient engagement with treatment and decrease opioid use, and use of medications for opioid use disorder after nonfatal overdoses decreases mortality. Summary A substance use intervention team (SUIT) service was established to offer universal screening and consultation by an interdisciplinary team at our urban academic medical center. The SUIT program provides inpatient consultation services as well as medical and behavioral clinic visits to transition patients to long-term treatment and is comprised of physicians, nurse practitioners, a clinical pharmacist, social workers, and a nurse. Successes attributed to enhanced medication use as a function of having a designated pharmacist as an integral member of the team are highlighted. Our medical center initiated screening efforts in tandem with its interdisciplinary team and clinic. The team attempts to start appropriately selected patients with SUD on medications for SUD while hospitalized. From January through December 2018, 87.2% of patients admitted to the hospital received initial SUD screening. Of the patients who screened positive, 1,400 received a brief intervention by a unit social worker; the SUIT service was consulted on 880 patients, and multiple medications for SUD were started during inpatient care. Conclusion A screening, brief intervention, and referral to treatment service was successfully implemented in our hospital, with the SUIT program in place to provide interdisciplinary addiction care and initiate medications for SUD in appropriate patients.

Role of the pharmacist in acute care interventions for opioid use disorder: A scoping review

“…In total, seven articles were included in this review (Table 1): Four articles described initiatives aimed at harm reduction for individuals with OUD, [18][19][20][21] and three articles described initiatives aimed at increasing MOUD initiation or improving MOUD management in the acute care setting. [22][23][24]…”

“…Two studies describing the implementation of services to increase prescribing of MOUD, one in the inpatient setting 22 and one in the ED, 23 were included. A third study describing a pharmacist-led pain management consult service for patients with histories of SUD was also included.…”

“…The first of these studies described the Substance Use Intervention Team (SUIT), an interdisciplinary inpatient consult service implemented at a single 729-bed urban academic medical center. 22 This team consisted of a medical toxicologist, a psychiatric nurse practitioner, a clinical pharmacist, LSW, and a registered nurse. All patients admitted to the hospital were screened by nursing using the National Institute on Drug Abuse quick screen and, if positive, were then screened by the LSW using the Alcohol Use Disorders Identification Test and Drug Abuse Screening Test.…”

“…At least 49 patients were also treated with medications for alcohol use disorder. 22 The second study likewise described a program designed to facilitate initiation of medications for SUD, specifically MOUD, however was based out of a single-center, high-volume ED. 23 This initiative to pilot a MOUD bridge program was led by a pharmacist and emergency medicine physician with support from the California Health Care Foundation.…”

“…In all three of these studies, pharmacists had significant involvement in operationalizing MOUD interventions. [22][23][24] The pharmacist involved with the SUIT consult service in the first study oversaw the medication use process by building flow sheets, medication counseling templates, withdrawal and SUD medication order sets, and making medication decisions related to the service (eg, supply, administration policies, staff education and medication review, and discharge medication access). 22 Likewise, the pharmacists in the second and third studies played important roles in developing protocols for buprenorphine management.…”