When addressing how to manage patients with opioid use disorders (OUDs) in the ED, much of the focus is on the physician’s role. However, experts stress that new solutions and programing in this area need to include emergency nurses.
“Nurses have a critical role in determining the degree to which a patient feels accepted and safe,” stresses Erik Hess, MD, MSc, vice chair for research in the department of emergency medicine at the University of Alabama at Birmingham (UAB) School of Medicine and principal investigator of a new ED medication-assisted treatment (MAT) program there. “They typically have the most interaction with patients during their medical encounters ... so they need to understand the disease of addiction and the fact that effective treatments are available.”
Patricia Kunz Howard, PhD, RN, CEN, CPEN, TCRN, NE-BC, FAEN, FAAN, president of the Emergency Nurses Association (ENA) and enterprise director for emergency services at the University of Kentucky HealthCare, wholeheartedly agrees with these sentiments. “One of the biggest challenges emergency nurses face is being on the frontlines of the opioid crisis. We’ve been a leading voice in the effort to find educational, legislative, and real-world ways to help patients who are struggling with OUDs.”
For example, ENA recently unveiled its Opioid Bundle (Learn more at: ), an array of resources designed to help nurses meet the needs of patients they encounter with OUDs. Howard notes that the bundle includes online education resources, recently published articles, and an ENA Naloxone Education Toolkit that is a comprehensive resource in and of itself.
“The toolkit has resources designed to help educate patients and family members about opioid ODs [overdoses] as well as instruction on how to distribute and properly use a naloxone kit [to reverse an OD],” she explains. “There are also step-by-step instructions on how to implement a custom opioid OD prevention program in individual EDs.”
In addition, the bundle contains posters and flyers that include tips on how to identify an OD and what can be done to save a patient’s life. Further, Howard notes there are expert presentations that discuss the realities of the opioid crisis, both on the streets and in the ED.
While the ENA takes no position on how involved emergency physicians should be in treating addiction, Howard acknowledges that her group is aware that there is a greater push in the ED for physicians to be able to prescribe the medications involved with MAT, such as buprenorphine or Suboxone (buprenorphine/naloxone). “We are certainly supportive of anything that is going to improve clinical outcomes for patients,” she offers.
One of the biggest challenges facing nurses is the lack of treatment resources available in many communities; this makes it difficult to make discharge plans for patients with OUD, Howard explains. “Every patient deserves to be treated with respect, to have a medical screening exam to determine [whether] an emergency exists, and to get the care that they need,” she says.
Unfortunately, many patients do not wish to receive treatment for their OUD, Howard notes. “We walk a fine line of making sure that we give the right information to each patient ... but not all of our patients are ready to learn the information we have to share with them,” she says.