Clinical Practice Change: Suboxone Use in Inpatient Psychiatry

Abstract

The opioid epidemic is public health crisis with veterans twice as likely as civilians to die from opioid overdose (National Council on Alcoholism and Drug Dependence [NCADD], 2017). The VA prescribes Suboxone in the outpatient setting; however, data suggests that patients with inpatient induction and linkage to outpatient services have better outcomes. The purpose of this quality improvement project was to implement and evaluate a clinical practice guideline for Suboxone induction in the inpatient setting. An educational quality improvement project was implemented to assess provider knowledge and attitudes of medication management and clinical practice guidelines regarding Suboxone. Provider knowledge and views were assessed. Adherence to clinical practice guidelines was assessed using a provider self-report tool to document patients screened for eligibility, admitted, and given a prescription. Seven providers attended the education intervention and completed the pre- and post- surveys. Provider knowledge improved 49%. Provider views regarding the new practice were high at baseline and remained relatively unchanged. Ten veterans were screened for eligibility, with two veterans consenting to admission. This quality improvement project, while limited, demonstrates that educational support prior to adoption of a new practice may enhance provider knowledge and is feasible. Screening for opioid addiction and identifying eligible patients has the potential to help providers achieve optimal health for their patients. Future projects are needed to evaluate success of this practice adoption.