The Centers for Disease Control recently announced that for the first time ever, the number of Americans who died from a drug overdose in the past year has surpassed 100,000.
"The opioid epidemic is raging," said Alëna Balasanova, MD, director of addiction psychiatry education and an assistant professor in the UNMC Department of Psychiatry. "The rate of overdose in Nebraska may be lower than other states, but it has increased, too."
Treating patients suffering from addiction is a passion for Dr. Balasanova. After her arrival at the med center in 2016, she worked with stakeholders across Nebraska Medicine and UNMC to implement several important initiatives aimed at better serving patients suffering from addiction, including the creation of the addiction services clinical program and inpatient consult service in 2019 at Nebraska Medical Center.
"We set our sights on the inpatient environment to provide a more reliable continuum of care to patients who are experiencing opioid withdrawal," she said.
Dr. Balasanova’s latest passion project will go live on Monday, Dec. 13, at Nebraska Medical Center. It’s a new order set in One Chart called the "Opioid Withdrawal Order Set," which can be ordered by the patient’s primary team.
"It’s designed to provide a systematic way to assess a patient’s opioid withdrawal and provide evidence-based treatment options," she said.
The order set involves various disciplines, including nursing, addiction psychiatry, pharmacy and the primary care team.
It also incorporates the Clinical Opioid Withdrawal Scale (COWS), which allows a nurse to perform an assessment on a patient who has either indicated opioid use or is showing symptoms of withdrawal.
Upon completion of the assessment, a score is calculated in the system. An appropriate medication treatment option is presented to the primary team to initiate based on a patient’s score.
For example, if a patient’s assessment results in a COW score of 13, One Chart will recommend a PRN order of 10 milligrams of methadone, a medication that lessens the painful withdrawal symptoms. The nurse would then reassess eight hours later.
"Creating an order set is no small feat," Dr. Balasanova said. "It took two years, working with many disciplines and presenting to many committees to be able to accomplish this."
Dr. Balasanova said the order set, together with the med center's addiction psychiatry consult service, puts the med center in a category with few other health systems.
"It really puts us at the forefront of patient care related to opioid use disorders and on the honor roll with Epic," she said. "We went from having zero addiction services available to patients in 2016 to now being a national leader in addressing opioid use disorder and withdrawal in hospitalized patients."
Those who work in the inpatient environment are encouraged to take a short module in Apollo to learn more about the Opioid Withdrawal Order Set. The module is called "Opioid Withdrawal Management" and can be found by searching "Opioid."
"This new order set is an example of our iTEACH value of innovation," said Sue Nuss, PhD, chief nursing officer at Nebraska Medicine. "Along with the associated training in Apollo, this protocol will ensure that Nebraska Medicine patients suffering from opioid withdrawal receive state of the art treatment and follow-up care."
Well done, Dr. Balasanova!
Great work, Dr. Balasanova!