Page 3 - FOCUS December 2017

Now 23, he is clean and runs a landscaping business as he and his young family plan to build a new home in Middletown.
“I always said I wanted to achieve these goals, but to sit back and see them actually take off, it’s a lot different now,” Blanco said.
Blanco was one of the first patients to benefit from Christiana Care’s opioid withdrawal clinical pathway, which was piloted in four hospital units in May 2016 and launched systemwide the following November. This medical road map helps the hospital care team to better identify patients at risk for opioid addiction and guide them into effective treatment. Today, almost all patients admitted to the hospital are screened for withdrawal and evaluated for buprenorphine and discharge to a community provider.
“The hospital is a reachable moment,” Dr. Horton said. “With the right tools, methods and staff, we are able to help identify those with substance use disorders, engage them by addressing withdrawal and facilitate their transition to community-based treatment.”
Blanco recently returned to Christiana Hospital to visit with one of the people he credits with turning his life around: patient care facilitator Dori Barnes, BSN, RN-BC.
“I just wanted to do the right thing,” Barnes said. “I saw a kid, a young boy who deserved to get out of where he was.”
She and her colleagues were able to help him achieve that, using the processes and tools of the clinical pathway. Among them is a simple screening tool developed at Christiana Care that consists of two questions:
“Have you used heroin or prescription pain medicines other than prescribed in the last week?”
“Do you get sick if you don’t use heroin, methadone or prescription pain medications?“
“Most patients who know they will go through withdrawal answer yes,” said Patty McGraw, MS, BSN, RN, research coordinator for the Department of Medicine.
Patients who answer “yes” to either question are entered into the pathway and systematically evaluated using the Clinical Opiate Withdrawal Scale (COWS) to look for signs including
Dori Barnes, BSN, RN-BC and Austin Blanco.
“I just wanted to do the right thing. I saw a kid, a young boy who deserved to get out of where he was.” Dori Barnes, BSN, RN-BC
restlessness, chills, flushing, tremors, runny nose, vomiting and diarrhea, which may indicate opioid withdrawal.
Christiana Care is validating the screening tool with an eye toward creating a national standard to help fight the country’s opioid epidemic.
Once identified, patients can be guided into medication-assisted treatment and therapy. Medication can relieve symptoms of withdrawal and prevent overdose deaths, and therapy can help address the trauma that is so often at the root of addiction.
“This is a population that oftentimes is very difficult to treat, not only for their medical complexity, but for the extraordinary challenges experienced during withdrawal,” said LeRoi Hicks, M.D., MPH, FACP, Hugh R. Sharp Jr. Chair of Medicine and physician leader of the Acute Medicine Service Line. | CONTINUED
e B RC I OG V H E T R H S E T A OL T R HY
“The opioid epidemic is a major catastrophe hitting our community.” Terry Horton, M.D., FACP, FASAM
DECEMBER 2017 FOCUS • 3