Strategic Question: What methods will the community employ to offer gold-standard, evidence-based treatment options for patients with Opioid Use Disorder (OUD)?
Implementation Plan: Chester County Hospital will partner with community leaders in OUD treatment to address inconsistencies in treatment of this population.
In 2017, the US Department of Health and Human Services declared a public health emergency and unveiled a five-point plan to combat the opioid epidemic, including improving access to treatment and using medications to reverse an overdose.
However, the opioid epidemic had already taken a devastating toll on the US and continues to do so. Every day, over 130 people lose their life due to an opioid-related drug overdose.
The impact of opioid use is expansive. Not only does it contribute to the deaths of millions, but it can also lead to problems in newborns who were exposed to opioids while in the womb, which is called neonatal abstinence syndrome (NAS). Complications can range from birth defects to premature birth to developmental problems.
In August 2018, Chester County Hospital took action to address the growing concern by organizing a multidisciplinary task force focused on improving the care delivered to patients with opioid use disorder in Chester County, PA.
"We know that we see opioid use disorder in the community. In 2017, there were 144 accidental overdoses in Chester County — many of them due to opioid or heroin," Heather Teufel, pharmacist at Chester County Hospital and leader of the CCH Opioid Task Force, shared.
The hospital’s multidisciplinary opioid task force, consists of:
- Physicians
- Bedside nurses
- Social workers
- Pharmacists and pharmacy managers
- Quality managers
- Information specialists (IS)
- Nursing managers
- Representatives from Chester County Drug and Alcohol Services
- Additional individuals, as needed
While Teufel takes the lead in organizing the task force, the variety of team members is integral to its effectiveness
"Together, the members have helped to address barriers and change perceptions among our clinicians in regards to caring for patients with OUD," Teufel said.
The goal of the task force is simple and straightforward — and crucial to the patients at CCH. It works to provide evidence-based treatment to patients with OUD, including the use of medication-assisted treatment (MAT), such as buprenorphine products or methadone, as well as a warm hand-off to the community.
A warm-hand off is exactly what it sounds like — a way to compassionately ensure patients with OUD have the resources they need when they leave the hospital.
"We take the next step to make sure patients are connected with an outpatient treatment provider. We don’t just give them a packet of resources and tell them who to call to make an appointment," explained Teufel.
These resources can range from rehabilitation centers to outpatient providers to support groups — or a combination of all three. The task force also makes sure patients know which resources will be supported by their insurance and what they can expect to pay out of pocket. This way, they can prevent any financial surprises or complications from occurring down the road.
A patient case can end up in the hands of the task force in a number of ways. They run reports on patients that are currently receiving medication-assisted treatment for OUD, and patients can also check "yes" to drug use on their admission paperwork. And sometimes, all it takes is a simple physician referral that leads the task force to assist in the management of care.
In the future, the task force will be establishing an alert through PennChart, the health system’s electronic medical chart, which will notify the team if a patient has specific criteria that could be associated with a substance use disorder. "This alert will be utilized to identify patients who arrive in the emergency room with a complaint, history, or medication that may be indicative of OUD," Teufel shared.
The alert will be sent directly to the task force using a HIPAA (Health Insurance Portability and Accountability Act) compliant application.
Similar to any addiction, patients with OUD aren’t always aware or willing to accept that they have a problem. Other times, however, patients walk into the emergency department seeking help to fight their addiction. Because of the various stages patients with OUD may be in, the task force needs to be ready to meet them wherever they might be.
"We are currently identifying what evidence-based treatment options or referrals we should offer to patients based on where they are in understanding their disease process," Teufel said.
The opioid epidemic is still a new concern for the country, and new evidence is continuously being presented to the healthcare community regarding effective treatment. Improvement and progress are critical to the functioning of the Opioid Task Force at Chester County Hospital.
"We regularly discuss patient cases in order to identify gaps in our current processes in order to develop action plans for improvement," Teufel explained.
The task force can have a number of roles in the care of a patient with opioid use disorder — all of them equally crucial to the well-being of the patient.
A Look at The Opioid Epidemic in Pennsylvania
- From 2016 to 2017, the rate of deaths caused by drug overdose deaths rose by 17% (the majority of which were opioid-related).
- In 2017, providers wrote nearly 60 opioid prescriptions per every 100 people.
- In 2017, 1,912 neonatal cases involved the use of drugs like opioids during pregnancy.
Breaking Down the Stigma of Opioid Addiction
The opioid epidemic has challenged the perspectives and understanding of everyone in the country, including providers who prescribe opioids, patients who develop OUD, and loved ones who are affected.
One of the most significant roadblocks in addressing this epidemic is the stigma that is often associated with addiction. Fear of this stigma can keep patients with OUD from seeking the treatment they need, which leads to poor health outcomes. Patients may feel discriminated against, ashamed, and misunderstood by both their healthcare providers and loved ones.
Breaking this stigma is a critical aspect of treating opioid use disorder, and it’s one of the task force’s primary goals. This comes largely from raising awareness around opioid use disorder — and addiction in general.
"We work collaboratively with partners in the community to break down the barriers to connecting patients with evidence-based treatment. We want to see our community members who suffer from addiction have a chance to recover," Teufel shared.
The task force’s impact goes beyond providers at Chester County Hospital and deep into the community of Chester County. In September 2019, they hosted a speaker panel called "Voices of Recovery", hich featured patient experiences with treatment, recovery, and maintaining sobriety. The goal was to provide education to the community and increase awareness using real stories from Chester County patients affected by OUD.
Science-Driven Solutions
Stigmas and biases are only one aspect of addressing the opioid epidemic. Treatment needs to be effective in order to get patients with OUD the support they need. The task force works closely with providers at Chester County Hospital to help them utilize medication-assisted treatment (MAT) to support patients.
MAT has been a game-changer for opioid addictions. It has been proven to decrease opioid use and opioid-related overdose deaths. It also can reduce criminal activity and infectious disease transmission that is associated with OUD.
Patients who receive medication-assisted treatment are more likely to improve social functioning and stay on their course of treatment, including therapy and support groups. And for women who are opioid-dependent and pregnant, MAT reduces the symptoms associated with neonatal abstinence syndrome (NAS) and their length of stay in the hospital.
The task force works diligently to stay up-to-date on the most effective treatments and ways to access patients who need help. For instance, they uncovered that patients who begin MAT in the emergency department are more than twice as likely to continue treatment compared to patients who are referred for treatment. At Chester County Hospital, they take advantage of the emergency department as a primary access point for opioid use disorder screening.
Successful treatment for OUD is not just about science, however, according to Teufel.
"Patients with OUD need to be shown compassion on top of being offered evidence-based treatment options to decrease their withdrawal symptoms and cravings and increase their likelihood of entering recovery."
A Community Effort: Fighting the Opioid Epidemic in Chester County
Just as the task force draws on multiple disciplines within its hospital walls, the success of the opioid task force at Chester County Hospital depends largely on the support of the community. The collaboration between Chester County Hospital and community services is critical to ensuring patients in the community receive the services they need.
For instance, the task force works with Chester County Drug and Alcohol Services and the Regional Overdose Prevention Coalition to find ways to reduce harm in patients with OUD.
"We have distributed at least 40 doses of naloxone nasal spray to patients at risk for an opioid overdose — free of charge and donated by the county," Teufel shared. Naloxone nasal spray reverses the effects of an opiate overdose, and it has the power to reduce thousands of deaths each year and offer patients a second chance to get long-term treatment.
The task force also collaborates with the Coatesville Comprehensive Treatment Center — often referred to as the "Methadone Clinic" — to establish pathways to streamline care for patients who are referred there from Chester County Hospital.
The goal is to complete that warm hand-off to the community — and the task force is constantly gathering information on how to do that successfully.
Caroline Haggerty, RN, manager of quality and patient safety at Chester County Hospital, leads the maternal and child care branch of the task force, explained, “The task force functions effectively because it is a collaboration of hospital and community members from multiple disciplines who have expertise with the clinical and social impacts of OUD. It also helps that the Chester County Hospital and Penn Medicine leadership are committed to providing the resources needed to address the issues with the opioid crisis.”
The Chester County community also plays a crucial role in providing understanding and empathy to those impacted by OUD.
Haggerty added, "The opioid crisis has affected so many of us in the community. Nearly everyone knows someone who has personally been affected, whether it be themselves, a family member, a friend, or a co-worker."
Compassion is essential — from healthcare providers, loved ones, and community members alike.
The task force has made strides since it was established. However, Teufel noted that, along with the rest of the country, there is still progress to be made.
"We by no means have it all figured out, and we’re still in the early phases of really rolling out MAT induction pathways. We have done a lot to start to break down the stigma and biases in regards to treating patients with OUD or substance use disorders — but we have so much more to do," she explained.
Beating the opioid epidemic requires significant effort, and fortunately, the opioid task force at Chester County Hospital, is up to the task.