869 - A Faculty Opioid Stewardship Program Integrating Simulation Based Training With Standardized Patients
Friday, May 15, 2020
11:50 AM – 11:57 AM
Location: Capitol: Terrace Level
Participants should be aware of the following financial/non-financial relationships:
Michael Lamberta, MD: Nothing to disclose
Amish Aghera: No financial relationships or conflicts of interest
AnneMarie Cardell, MD: No disclosure data submitted.
Nubaha Elahi: No disclosure data submitted.
Sergey Motov, MD: No disclosure data submitted.
Reuben J. Strayer, MD: No disclosure data submitted.
Michael Lamberta, MD: Nothing to disclose
Intro/Background: The US Department of Health and Human Services declared the opioid crisis a public health emergency in 2017. Opioid misuse has resulted in a dramatic increase in deaths over the past 2 decades and imposes an enormous public health burden across the US. Particularly high are the rates of premature death in young Americans. This has resulted in a call for action to develop programs to mitigate the risk of opioid addiction and opioid-related deaths.
Purpose/Objective: The primary aim of the educational initiatives is to measure the impact of a multifaceted Opioid Stewardship Program leveraging simulation-based education to promote the development and utilization of systems-based solutions to mitigate the risk of opioid use disorder. Secondary aims include measuring changes in misconceptions around opioid use disorder and knowledge gains around strategies to mitigate risk of opioid misuse.
Methods: This is a prospective mixed-method study measuring the effect of simulation-based training (SBT) on the development of systems-based solutions to address opioid use disorders. ED Faculty learners participated in stations with standardized patients designed to mimic challenging clinical scenarios, ie drug-seeking behavior, opioid withdrawal, and acute pain management. Subjects completed pre and post-course surveys with free-response questions probing for their attitudes around opioid use disorders and their knowledge of treatment strategies.
Outcomes (if available): The post-course survey revealed overall positive reactions for 42 faculty learners. Over 90% reported the session was either 'quite' or 'extremely effective' in promoting good prescribing strategies, educating patients prescribed opioids, and highlighting strategies for administering buprenorphine. Free-text responses emphasized a commitment to opioid responsible practices through prescribing less euphoria-inducing opioids, improving comprehensive discharge instructions, and better awareness of both the community and institutional resources available to support patients dealing with opioid use disorder.
Summary: An emerging concept in the fight against opioid misuse is Opioid Stewardship, which has been described as “coordinated interventions designed to improve, monitor, and evaluate the use of opioids to support and protect human health”. Key elements of a recently successful Opioid Stewardship Program (OSP) implemented across a large health system included a multifaceted approach to impact opioid prescribing, addiction services, information technology tools, and provider education.
Many educational programs around opioid misuse revolve around traditional didactic methods of teaching. Even commonly accessible online modules are grounded in passive educational strategies. In order to effectively change misconceptions about opioid use disorder, it is critical to engage practitioners initiatives that promote critical self-reflection. Through the use of deliberate practice, and structured debriefing, simulation-based training is ideally suited to uncover erroneous misconceptions and behaviors. Furthermore, simulation that integrates the use of standardized patients enables practitioners to improve complex communication skills such as motivational interviewing, which is critical to help patients suffering from opioid addiction contemplate change.
Simulation faculty developed 3 stimulation scenarios with standardized patients based on 1) Strategies in acute pain management 2) Management of patients in acute opioid withdrawal and 3) Approach to a patient after a non-lethal overdose of opioids. Over 13 weeks, 3-4 faculty met for 2 hours to first discuss practices and biases surrounding patients with opioid use disorder. Faculty then rotated through each scenario and de-briefed individually and as a group. Knowledge gained and goals for practice change were recorded in a post-course survey.
The initial reactions of our learners to this initiative have been positive. Ongoing research is evaluating practice change by monitoring opioid prescribing practices, utilization of outpatient resources for opioid use disorder, and tracking faculty who electively engage in X-Waiver training to provide other treatment options for those with opioid use disorder.