Safety and preliminary outcomes of short-acting opioid agonist treatment (sOAT) for hospitalized patients with opioid use disorder.

BACKGROUND: Patients with opioid use disorder (OUD) frequently leave the hospital as patient directed discharges (PDDs) because of untreated withdrawal and pain. Short-acting opioids can complement methadone, buprenorphine, and non-opioid adjuvants for withdrawal and pain, however little evidence exists for this approach. We described the safety and preliminary outcomes of short-acting opioid agonist treatment (sOAT) for hospitalized patients with OUD at an academic hospital in Philadelphia, PA. METHODS: From August 2021 to March 2022, a pharmacist guided implementation of a pilot sOAT protocol consisting of escalating doses of oxycodone or oral hydromorphone scheduled every four hours, intravenous hydromorphone as needed, and non-opioid adjuvants for withdrawal and pain. All patients were encouraged to start methadone or buprenorphine treatment for OUD. We abstracted data from the electronic health record into a secure platform. The primary outcome was safety: administration of naloxone, over-sedation, or a fall. Secondary outcomes were PDDs and respective length of stay (LOS), discharges on methadone or buprenorphine, and discharges with naloxone. We compared secondary outcomes to hospitalizations in the 12 months prior to the index hospitalization among the same cohort. RESULTS: Of the 23 cases, 13 (56.5%) were female, 19 (82.6%) were 40 years or younger, and 22 (95.7%) identified as White. Twenty-one (91.3%) regularly injected opioids and four (17.3%) were enrolled in methadone or buprenorphine prior to hospitalization. sOAT was administered at median doses of 200-320 morphine milligram equivalents per 24-h period. Naloxone administration was documented once in the operating room, over-sedation was documented once after unsanctioned opioid use, and there were no falls. The PDD rate was 44% with median LOS 5 days (compared to PDD rate 69% with median LOS 3 days for prior admissions), 65% of sOAT cases were discharged on buprenorphine or methadone (compared to 33% for prior admissions), and 65% of sOAT cases were discharged with naloxone (compared to 19% for prior admissions). CONCLUSIONS: Pilot implementation of sOAT was safe. Compared to prior admissions in the same cohort, the PDD rate was lower, LOS for PDDs was longer, and more patients were discharged on buprenorphine or methadone and with naloxone, however efficacy for these secondary outcomes remains to be established.

The Use of Structured, Active, In-Person Learning to Connect Didactic Content with Clinical Scenarios in a Senior Level Nursing Leadership Course.

BACKGROUND: The senior leadership course at the University of Pennsylvania School of Nursing includes both didactic and clinical components. The didactic portion delves into leadership topics and during clinical rotations the students witness nurses and patients navigate through complicated and emotional patient care experiences. METHOD: Structured, active, in-class learning (SAIL) activities in a classroom were used to connect didactic content with clinical scenarios. Different specialty-related clinical scenarios were presented to the students, and they were allocated a certain amount of time for discussion in small groups before sharing their outcomes with the whole group (think-pair-share). RESULTS: Student evaluations showed that the percentage of students who rated each session as excellent increased each semester and feedback remained overwhelmingly positive; the consistently identified area for improvement is the timing and we plan to lengthen the sessions to address that. CONCLUSION: Our team discovered that by shifting most of our simulation scenarios to SAIL, we provided the students with ample opportunities to speak in a dialectically rich environment about clinical scenarios while maintaining the interrelation between theory and practice. [J Nurs Educ. 2023;62(4):257-262.].