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Workflow can be defined as a well-structured, orchestrated, and repeated pattern of nursing activity. Since the steps of workflow are highly predictable, it is easy to present the described operation visually – for instance, in a flowchart or a diagram. Flowcharts and diagrams are recognized as useful tools in the workplace aimed at setting standards for conducting certain procedures, staff training, and continuing education. The present paper contains a flowchart for SBIRT screening for opioid abuse – a complex process that needs to be mastered by many nurses. The essay provides a brief explanation of the flowchart, examines evaluation metrics, and highlights areas of improvement.
Explanation of the Diagram
Opioid medication is often prescribed for pain relief due to its effectiveness. However, this type of medication is highly addictive and should be taken with the utmost caution (Volkow & McLellan, 2016). Opioid overdose leads to difficulties breathing, slow heartbeat rate, extreme weakness, and inability to speak, and in some cases, opioid abuse may be lethal. SBIRT stands for Screening, Brief Intervention, Referral and Treatment and is a standard procedure for assessing the risks of opioid abuse in medicated patients. The steps a nurse needs to take to evaluate a patient’s physical and mental state are similar to those taken in the case of any other type of substance abuse (Kentuckiana Health Collaborative, 2018). Once a patient is admitted to a care facility, a nurse should ask him or her about their daily intake of opioid medication.
If the intake exceeds that prescribed by their doctor, the screening is positive, and the nurse should consider taking the following steps presented in the diagram. At this stage, it is essential to conduct a risk evaluation, for instance, using the Opioid risk tool. The author of the Opioid risk tool, Webster (n.d.) recommends asking questions about the family history of substance abuse, comorbidities such as mental disorders, and alcohol intake.
If a patient does not abuse the prescribed dosage significantly and regularly and his or her situation is low-risk, a nurse can advise to follow their doctor’s recommendations and be careful. If the risk is low to moderate, a nurse should intervene briefly: summarize the gathered data and tell about the possible adverse outcomes. While intervening, a nurse should be non-judgmental and compassionate to overcome a patient’s reluctance (Ideas Exchange, 2017).
In case the risk is moderate to high, brief treatment is recommended: for instance, a nurse can give information about less dangerous medication. Lastly, if a patient is undeniably at high risk of having or developing opioid abuse, he or she should be referred to other specialists and encouraged to join a therapy group. All the steps are value-added: they are usually done right the first time, have the potential to transform a patient, and are important to him or her.
Metrics and Areas of Improvements
The implementation of hospital staff performance metrics can tackle the epidemic of opioid abuse. The use of opioid medication is tracked by health providers and available in common databases. A nurse shares information about opioid prescription with local providers so that a patient is not able to receive drugs from other sources. The most important evaluation metric is a reduction in unnecessary use and improved access to less aggressive medication ibuprofen which can help to tackle dependency issues. Another metric that can be implemented for assessment is a lower readmission rate after initial referral.
The workflow for SBIRT presented in the diagram leaves some space for improvement. It describes an ideal situation in which a patient is honest and direct and shares personal data without reluctance. A diagram could benefit from an additional part in which a patient conceals information, but databases at a nurse’s disposal show that he or she is abusing drugs. The next step might include handling treatment or referral refusal.
Patients suffering from severe pain often make attempts to increase the dosage of opioids since they discover that their organism adjusts to the effect of medication and no longer reacts in a desired way. Conducting regular screenings can be of great help with exposing abuse cases whereas maintaining workflow helps to organize resources systematically and increase the efficiency of work processes. A nurse needs to approach the screening process in three steps: ask initial questions about daily intake, assess risks, and choose between intervention, treatment, or referral. The efficiency of SBIRT can be measured through reduced use of opioids and fewer readmissions. The workflow can be improved by adding more details and establishing the course of action in the case of a patient’s refusal to cooperate.
Ideas Exchange. (2017). The SBIRT interview: Opioid screening [Video file]. Web.
Kentuckiana Health Collaborative. (2018). Screening, brief intervention, and referral to treatment (SBIRT). Addressing unhealthy substance use in primary care settings. Web.
Volkow, N. D., & McLellan, T. (2016). Opioid abuse in chronic pain. Misconceptions and mitigation strategies. New England Journal of Medicine, 374(13), 1253-1263.
Webster, L. R. (n.d.). Opioid risk tool. Web.