Mitigating Accidental Overdose with Improved Screening for Critical Knowledge Gaps in Opioid Users

Abstract

Purpose: This DNP quality improvement project aimed to assess provider knowledge and perceptions regarding the utility of a standardized tool designed to detect critical knowledge gaps in patients who use prescribed and/or illicit opioids; and to make a screening tool available for providers to incorporate into their practice. This project pertains specifically to providers in an integrated care setting. Background: Approximately 67.8% of fatal drug overdoses involved opioids in the US in 2017. In Arizona, as many as 28,827 opioid related overdoses occurred since June 15, 2017. Most overdoses are ruled accidental. Psychiatric and primary care providers at integrated care facilities routinely see patients who use opioids. Critical knowledge gaps can be assessed in patients using opioids with a screening tool. Methods: A one-group pretest-posttest pre-experimental design was used. The sample included psychiatric and primary care providers with prescriptive authority, and psychotherapists, all of whom treat adult patients who use opioids. Participants were recruited in person, received a brief educational session, and completed pre- and post-education surveys. The tool was disseminated to providers; a two-week follow-up assessed if providers implemented the tool into practice. Results: Provider knowledge scores improved after receiving the education intervention. Provider perceptions regarding the utility of a rapid screening tool indicated that providers view a screening tool favorably, see screening as a high priority, and believe most (or all) patients should be screened. Free-text responses from providers indicated concerns about how to use the screening tool in a standardized fashion. At two weeks, providers had not implemented the tool into their practice, and were uncertain of how to implement the tool in a standardized fashion. Conclusion: A small group of providers in an integrated care setting, consisting of primary care and behavioral health providers, favorably perceived the utility of a potential screening tool designed to detect critical knowledge gaps in patients who use opioids. Providers were not certain how to use the screening tool in a standardized fashion, which can be the topic of focus in a subsequent iteration of this DNP project.