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2 results

  • Adapting to COVID-19 at arch

  • A. Selladurai, C. Goedhuis, J. Fehler
  • Journal:
    European Psychiatry / Volume 64 / Issue S1 / April 2021
    Published online by Cambridge University Press:
    13 August 2021, p. S574
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  • Introduction

    The Addictions Recovery Community Hillingdon (ARCH) is a specialist addictions treatment service, providing a range of inteventions for substance use disorders. The onset of the COVID-19 pandemic required healthcare services to rapidly adapt clinical care in order to safeguard patients and staff from contracting the virus whilst managing clinical risk. Key changes were made to treatment pathways at ARCH.

    Objectives

    1. Reduce face-to-face contact between patients and staff (including community pharmacists) 2. To get feedback from patients and staff about changes implemented

    Methods

    To reduce face-to-face contact, we aimed to decrease the number of patients having supervised consumption of Opiate Substitute Treatment (OST). Furthermore, telephone consultations were encouraged for keyworking and reviews. Patients were randomly selected and interviewed about their experiences and focus groups were be completed with staff.

    Results

    Supervised consumption of OST was reduced from 41.5% to 6%. Face-to-face appointments were significantly reduced and telephone consultations were introduced as standard. Telephone reviews became the standard method of contact for keyworking sessions and medical reviews. 53% of services whose interval between instalment collection of OST at community pharmacies was extended found it ‘easy’ or ‘very easy’ to adapt to. 61% of service users who had access virtual platforms finding it ‘easy’ or ‘very easy’ to access support. Focus groups of staff members revealed that stafff felt the changes in instalment collection of OST was positive for patients.

    Conclusions

    ARCH implemented a number of changes to treatment pathways and inteventions to minimise the risk of virus transmission amongst patients and staff whilst managing clinical risk.

  • P069: Implementing supervised consumption service access for emergency department patients

  • N. Lam, R. Rosenblum, T. Kaban, K. Dmitrienko, D. Oczkowski, K. Dong
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
    Published online by Cambridge University Press:
    13 May 2020, p. S89
    Print publication:
    May 2020
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  • Background: Unintentional opioid overdoses in and around acute care hospitals, including in the ED, are of increasing concern. In April 2018, the Addiction Recovery and Community Health (ARCH) Team at the Royal Alexandra Hospital opened the first acute care Supervised Consumption Service (SCS) in North America available to inpatients. In the SCS, patients can consume substances by injection, oral or intranasal routes under nursing supervision; immediate assistance is provided if an overdose occurs. After a quality assurance review, work began to expand SCS access to ED patients as well. Aim Statement: By expanding SCS access to ED patients, we aim to reduce unintentional and unwitnessed opioid overdoses in registered ED patients to 0 per month by the end of 2020. Measures & Design: Between June 13-July 15, 2019, ARCH ED Registered Nurses were asked to identify ED patients with a history of active substance use who may potentially require SCS access. Nurses identified 69 patients over 43 8-hour shifts (range 0-4 patients per shift); thus, we anticipated an average of 5 ED patients per 24-hour period to potentially require SCS access. Based on this evidence of need, ARCH leadership worked with a) hospital legal team and Health Canada to expand SCS access to ED patients; b) ED leadership to develop a procedure and flowchart for ED SCS access. ED patients were able to access the SCS effective October 1, 2019. Evaluation/Results: From October 1 to December 1, 2019, the SCS had 35 visits by 23 unique ED patients. The median time spent in the SCS was 42.5 minutes (range 14.0-140.0 minutes). Methamphetamine was the most commonly used substance (19, 45.2%), followed by fentanyl (10, 23.8%); substances were all injected (91.4% into a vein and 8.6% into an existing IV). In this time period, there were zero unintentional, unwitnessed opioid poisonings in registered ED patients. Data collection is ongoing and will expand to include chief complaint, ED length of stay and discharge status. Discussion/Impact: Being able to reduce unintentional overdoses and unwitnessed injection drug use in the ED has the potential to improve both patient and staff safety. Next steps include a case series designed to examine the impact of SCS access on emergency care, retention in treatment and uptake into addiction treatment.