1

Health Policy Brief-Revising the Opiate Withdraw Order Set

Christan Mulder
Western Washington University

Statement of the Issue

2
The Whatcom County Health Department reports that opiate abuse has risen dramatically
over the last several years and as of 2009 Whatcom County ranked 3rd in the state from overall
negative impacts from Heroin abuse. The Center for Disease Control and Prevention states that
heroin use and heroin related deaths have nearly quadrupled between the years 2002 and 2013
and that improvement strategies must be implemented at every system level (CDC, 2015).
PeaceHealth St. Joseph Medical Center (SJMC) nurses must be equipped with the best available
resources and tools to assist in treating and further preventing the heroin epidemic in our
community.
Issue and Background
The care of the substance abuse patients is a complex process that includes ongoing
assessments, treatment of possible intoxication/withdrawal symptoms and treatment of cooccurring psychiatric diagnoses. Developing a treatment plan for these patients goes above and
beyond the care of the physician. To provide medical care in a way that is consistent with the
PHMCs mission and values we must work together to improve substance abuse care.
The current opiate withdrawal protocol utilized by PHMC follows a fairly narrow
approach and is in need of a revision and update in order to facilitate and increase patient success
rates. The Registred Nurse caring for these individuals must be equipped with the best possible
medications and treatments available. Our hospital must face this epidemic with a
comprehensive approach and will begin by evaluating and revising the care provided to
substance abuse patients. Amendment of the opiate withdrawal protocol would expand drug
abuse treatment for the hospitalized patient and will encompass multiple factors that affect the
addicted patient during and after hospitalization. As the current opiate withdrawal order set
addresses simply only withdrawal, the new order set addresses a multitude of factors that
emotionally and physically promote good health. The nursing staff caring for these individuals
using the current order set often feel limited with treatment options available therefore causing
negative feelings and low levels of professional satisfaction relating to limitations of care being
provided.
Not every patient admitted to the hospital is ready for detox. The new order set provides
options for managing the symptoms of withdrawal but also provides treatment options for
ongoing maintenance therapy or even just stabilization during their hospital stay. With antibiotic
resistance becoming more and more common especially among intravenous drug users its

3
important that all patients finish the prescribed antibiotic treatment. By providing additional
pharmacological therapies to manage the symptoms of withdrawal or enabling and supporting a
patient in ongoing treatment options we will begin to see a decrease in the number of patients
who leave against medical advice or leave simply prior to finishing antibiotic therapy.
Position on the Issue
The floor nurses providing direct care for these patients, advocating, coordinating and
evaluating care must be equipped with a better set of tools. The care that an RN provides for a
substance abuse patient during hospitalization is not limited to ongoing assessments, treatment
planning, psychosocial support, medication administration and monitoring, and coordinating a
discharge plan with the possibility of the patient to enter into recovery. PHMCs new opiate
withdrawal order set allows for a more comprehensive approach to care.
Providers resistance to change and personal judgements by all staff involved in the
patients care are possible barriers to utilization and implementation of the new order set.
Educational sessions and practice updates are available in order to facilitate the change process.
Recommendations

Revision of PHMC Opiate and Narcotic Withdrawal Order set to reflect the hospitals
goals, vison and mission.

Provide ongoing support of the drug addicted patient by allowing maintance therapy
options within PHMC and enable success of staying clean from drugs at discharge

Familiarize nurses, doctors and patients with medications being administered and
available to be ordered for patients experiencing withdrawals.

Formulate and provide educational opportunities for providers and nursing staff on the
detoxing patient, the symptoms of withdrawal and the benefits of the new opiate
withdrawal order set.

Benefits

The revised Opiate and Narcotic Withdrawal order set enhances workflow for all
providers and nurses and reduces the unintentional oversight and Eliminating variability

Reducing unnecessary calls to medical providers.

Enhanced Workflow and Flexibility for Providers

Increased patient/staff satisfaction

References

4
Center for Disease Control and Prevention. (2015, July). Vital signs: Todays
Heroin Epidemic. Retrieved from
http://www.cdc.gov/vitalsigns/heroin/index.html
Center for Disease Control and Prevention. (2016, January) Increases in Drug
and Opioid Overdose Deaths United States, 20002014.
Retrieved from
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm
Whatcom County Public Health Department. (2014). Opiate Addiction Fact
Sheet. Retrieved from
http://www.whatcomcounty.us/documentcenter/view/1738